Online Prescription Requests

Patients of Berwick Healthcare who require a repeat prescription can order a script by filling in the below details. Fill in the name of the medication and dosage you require. Allow 48 hours for the prescription to be actioned by your doctor, if you require your script sooner, please contact the clinic to arrange an appointment. A charge of $10 (or $10.56 if you use Paypal) is required for all scripts, this can be paid for by PayPal or at reception on collection.

No drugs of addiction, benzodiazepines or anti-depressants or anxiety medications will be prescribed using this system.

Please note only prescriptions previously prescribed by this clinic can be requested.

First Name

Surname

Medicare or OSHC number

E-mail

Phone Number

Date of Birth

Address

Medication Required

I confirm that I am a current patient of Berwick Healthcare

Yes

I agree that I have been prescribed this medication/s before

Yes

I confirm I am the above patient requesting the medication. Or the parent or guardian of a child under 16 or within my care.

Yes

I understand that this request is up to the doctor's discretion and my doctor may decline request due to medical reasons

Yes

One of the receptionists will contact you if this is the case.

I agree to have my e-mail saved with the Berwick Healthcare data base for future practice information

Yes

By Communicating electronically with Berwick Healthcare, I dismiss the practice from all claims, losses, expenses and liabilities caused by any problems in using electronic mail with the risk of interception by third parties and non-recipients.

I Agree

Online Prescription Requests

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