Radius Medical

Patients of selected medical centres may use this form to request repeat prescriptions for certain stable conditions. You will have to see your doctor for regular reviews and monitoring. Please allow up to two working days for your request to be processed. The usual repeat prescription charges apply. All sections marked with (*) must be completed.
For urgent requests please call your medical centre directly. In an emergency dial 111. Please follow guidelines for input on the right of the screen. * = required field

First name (*)

Please enter your first name

Last name (*)

Please enter your last name

Birth date (*)

Please enter your birth date: DD/MM/YYYY Please use this format: DD/MM/YYYY

Phone (*)

Invalid input - use numbers only, no gaps, eg 091234567 A DAYTIME number we can call you on.

Cell phone

Invalid input - use numbers only, no gaps Please add your cellphone number if you have one.

Email (*)

Invalid Input

My medical centre (*)
Davies CornerSt Andrews Silverstream The PalmsTi RakauRototuna Whakatane
Please select your medical centre.

My GP

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Your request

Please enter only one medication per line.

Medication 1

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Medication 2

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Medication 3

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Medication 4

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Medication 5

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Tell us how you would like to be contacted when your script is ready:

Any allergies? (*)

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Contact me by
Text messagePhoneEmail
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Please tell us how you will collect your prescription (please note there may be a charge for faxing it to your pharmacy):

Script collection
I will pick it up from the medical centrePlease fax to my pharmacy as below:
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Pharmacy

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Location

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Fax number

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Click this button to send us your request

be well

with radius medical group practices

Repeat prescription requests