Request a Prescription

PLEASE NOTE that there is a 24 hour turnaround for repeat prescription.
If this is a urgent request please phone the surgery (09) 524 5547, option 1.
We will contact you if we have any queries with your request.

Items marked with (*) are essential & MUST be completed.

Your Name*

Date of Birth*

Email*

Phone No.

Medication Required*

Prescription Delivery*

Collect From Surgery ($15.00 fee)  Post To Postal Address ($25.00 fee)  Fax To Pharmacy ($25.00 fee)

Full Name of Pharmacy

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