Repeat Prescription Order Form

Prescription Ordering Form

ADHD Medication: Ordering a Repeat Prescription

Please use this form if you are a registered patient and want to order a repeat prescription outside of a follow-up consultation. Your medication will be ordered from Cloud RX. Due to regulations we can only provide one months supply.

If you want to change your medication, please use our online diary to book a follow-up consult.

There is a fee of £30 to order a prescription (+£10 optional faster delivery of script to pharmacy).

Due to current legislation, your paper prescription has to be posted to the pharmacy prior to any medication being released. Delivery time frames are approximately 8 working days from ordering through to receiving medication.

I confirm I have read the above

Patient's First Name (as registered with us)

Please give the same first name that you gave when registering with our system originally.

Patient's Surname (as registered with us)

Please give the same surname that you gave when registering with our system originally.

Patient's Email (as registered with us)

Please give the same email address that you gave when registering with our system originally.

Patient's Date of Birth (dd/mm/yyyy)

What repeat medication would you like prescribed (type and dose)?

This must be a repeat and match what we have on file

PAYMENT

We charge £30 for a repeat prescription. This will be taken from the card attached to your account. If you have not stored your card, please call 01684 877 115 to pay (between 9.30 and 3pm).

I give permission to take £30 from the stored card

The pharmacy requires us to post your paper prescription using Royal Mail. The above includes first class postage. However Royal Mail time frames can vary greatly from 2 - 6 days. We recommend faster tracked delivery is added to your fee.

I give permission to take £10 for faster delivery of prescription to Cloud RX

Expectations of Time Frame

It may take 7-8 working days to receive your medication.

This may include 48 hours to action and post your prescription (depending on working hours), 2-3 days in transit, 48 hours pharmacy turnaround time, plus 24 hours transit to your home.

Please confirm:

I understand that I may need to wait 7-8 working days to receive my medication.

If I am concerned about a delay, I will initially contact Cloud RX on pharmacy@cloudrx.co.uk for an update