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Repeat prescription request

Repeat Prescription Request

Medication Required

Is there anything unusual about this request?

Please note that early issue requests are considered on an individual basis and cannot be guaranteed.

Will you be travelling:

Please note that replacement medication cannot always be issued.

Controlled drugs cannot normally be replaced early and additional evidence may be required.

Has the medication been:
Have you reported the incident to the police?
For example, taking a different dose, medication damaged, medication lost, medication stolen, going on holiday.

Hospital or specialist medication

Are any of the medications requested prescribed by a hospital or specialist and not normally issued by Horizon Healthcare?

Please use the file upload below to attach a recent hospital letter, clinic letter or discharge summary relating to the medication.

Without supporting documentation we may be unable to process your request.

Please provide any additional information relevant to your request.

Supporting documents

Please upload any supporting documents relevant to your request.

Examples:

  • Hospital letters
  • Discharge summaries
  • Police reports
  • Specialist correspondence
Maximum upload size: 67.11MB
Nomination
Confirmation