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Repeat Prescription Request

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Repeat Prescription Request


    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

    599 Wilmslow Rd, Manchester M20 3QD, UK


    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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