ADHD Medication Repeat Prescription Request

Prescription request form for existing clients

If you are happy with your current medication and dosage, you can request a repeat prescription. For any concerns or side effects, please contact us before submitting your request.

Your details

Please ensure all information provided in this form belongs to the client, as incorrect details may delay processing.

Full Name *

Date of birth *

Email address *

Phone number *

Consultant name

Health & Wellbeing Check These details help your consultant review the request safely.

Pulse rate

Blood pressure

Weight

Mood

Energy

Sleep

Appetite

Any side effects?*
NoYes

Any unusual thoughts, suicidal thoughts or experiences?*
NoYes

Additional wellbeing notes

Medication Details Tell us about the medication you need repeated.

Medication name *

Dose & strength *

Days remaining *

Do you have a Shared Care Agreement?*
YesNoNot sure

Additional InformationAdd anything else your consultant should know.

Message

Your information is secure and will only be used to process your request.

Important Information About Prescription Requests

The date and time you select in our prescription diary is not an indication of when your prescription will be processed. It is used only to submit your prescription request.

Please allow at least one week for your prescription request to be reviewed and processed.

All prescription requests are reviewed by our clinical team. Submission of a request does not guarantee that a prescription will be issued. If further review is required, you may be asked to book a follow-up consultation before your prescription can be approved.

Please note:

If you believe the £80 prescription fee may not be applicable to your request, please contact us directly on prescribing@adhdcentre.co.uk before submitting your request.
The cost of any prescribed medication is paid separately to your chosen pharmacy.
If a follow-up appointment is required, we will contact you to arrange the appointment. Any remaining balance must be paid before your appointment can be confirmed.
If a refund is due, it will be processed using the original payment method. Please allow 5–7 working days for the funds to appear in your bank account, although processing times may vary depending on your bank.

Prescription Fee

£80

Please note that there is a standard fee of £80 for issuing a repeat prescription outside of a follow-up appointment. This fee is payable in advance.
If you have any questions, please don't hesitate to give us a call using the contact details below.

Need help?

Our support team can help if you have a question before submitting your request.

Health & Wellbeing Check These details help your consultant review the request safely.

Medication Details Tell us about the medication you need repeated.

Additional InformationAdd anything else your consultant should know.

Complete Payment

Main Information

Our Expertise

Our Centre Address

Marylebone

Belgravia

Manchester Clinic

Postal Address

Health & Wellbeing Check These details help your consultant review the request safely.

Medication Details Tell us about the medication you need repeated.

Additional InformationAdd anything else your consultant should know.

Complete Payment

Main Information

Our Expertise

Our Centre Address

Marylebone

Belgravia

Manchester Clinic

Postal Address

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