Repeat Prescription Form

All prescriptions can be requested using our online form below. Please make sure to specify on the form how you would like to receive your medication.

We offer two options:

Post the Paper Prescription to You:
We can send the FP10 prescription directly to your home address. You can then take it to your local pharmacy to have it fulfilled.

CloudRx Online Pharmacy:
Alternatively, we can send the prescription to CloudRx, a fully licensed UK online pharmacy that specialises in private prescriptions. CloudRx will invoice you directly and post the medication to your home address.

Click here for more information about CloudRx

Repeat Prescription Form

Please note that our Nurse Prescriber (Helen Latch NMC: 96I5943E) is in clinic on Mondays and Fridays to review and action repeat prescription requests. We kindly ask that you allow at least 7 days’ notice when submitting your request to ensure it can be processed in time.

Thank you for your understanding and cooperation.

Children's Repeat Prescription Request 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