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Repeat Prescription Request

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Repeat Prescription Request












    Fullname:

    Date of Birth:

    Name of your Consultant:

    Home Address:

    Email Address:

    Telephone Number:

    Would you like your prescription sending to a different address?:*

    If yes, please add the address below and the reason for sending to this address:

    Current Pulse Rate(bmp):*

    Current Blood Pressure:/

    Current Weight(lbs):

    Mood, please describe your current mood*

    Energy: please describe your current energy levels:*

    Sleep: please describe your current sleep patterns*

    Appetite: please describe your current appetite levels*

    Any unusual thoughts, suicidal thoughts or experiences?*

    If you answered Yes, please describe*

    Medication Required & Dose*

    Medication Dose*

    How many days of medication do you have left*

    Prescription delivery:
    Would you like your prescription sending:*

    Anything else you wish to add?

    What happens next
    Your request will now be passed to your consultant. If they are able to send a repeat prescription we will then send you a payment link for this.
    PLEASE NOTE – there is no guarantee your consultant will be able to issue a repeat prescription and they may need to see you for a follow-up appointment before being able to do so. If this is the case we will come back to you with options for appointments.

    The ADHD Centre

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    ADHD Centre in London
    85 Wimpole St., Marylebone London, W1G 9RJ, UK

     

    Postal Address
    13304 PO Box 6945 London W1A 6US

    The ADHD Centre

    Who We Are

    We are a team of experienced Consultant Psychiatrists, Psychologists and ADHD Behavioural Coaches.

    We have been diagnosing and treating people with ADHD since 2009.

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