Prescription Request

Information about medication will be here soon.

Repeat Prescription Form

Patient Name *

Please complete a separate form for each patient if requesting for 2 or more patients

Patient date of birth *

Medication # 1, name and dose *

Medication # 2, name and dose

Medication # 3, name and dose

Name of parent/guardian requesting repeat medication *

Email address of parent/guardian requesting repeat medication *

Phone number of parent/guardian requesting repeat medication *

Address for delivery of the paper prescription *

Any other information

Please note that there will be a £35 charge for private prescriptions *

I agree

CloudRx *

I agree to use CloudRx
I want to receive a paper prescription, which I will take to a pharmacy

Our preferred option is to manage prescriptions with our online Prescription Partner CloudRx. CloudRx receive your prescription direct from Dr Cassie’s clinic and then post your medications to you within 72 hours. CloudRx charge a small delivery fee in addition to the medication cost. For further information, visit https://www.cloudrx.co.uk/frequently-asked-questions