You are welcome to use this contact form for prescription renewal and to request changes of appointment.
This is an encrypted site to ensure security of your data
IMPORTANT – After you have submitted the form the acknowledgement is not clear, so please ONLY submit the form once!
To enable us to fax a prescription we will need:
1. The name of your pharmacy
2. For each drug requested please specify
- Strength (the number eg 20 mg)
- Frequency (eg weekly, twice a day)
3. Put prescription in the subject line
(New patients must be referred by a physician)
For existing patients, requesting an earlier, cancelled or changed appointment, please leave details including:
1. When is your current appointment?
2. In what time frame would you like to be seen?
3. How do you wish to be contacted?
4. Put the word appointment in the subject line
We will call you back to arrange a new appointment