Repeat Prescription Request Form

Running low on HRT? Please complete the simple request form below.

Our team of Pharmacists and Nurses will check that:

You have been seen for a new or follow up appointment in the last 12 months.
Your request matches what you agreed with your clinician at your last appointment.

They will then issue a prescription as appropriate.

Please only fill in one request form for all your HRT.

If we have prescribed testosterone for you, you will need an initial blood test within 3-6 months of starting treatment, followed by a yearly review and blood test.

Please allow between 7-10 working days for your prescription to be sent to the Pharmacy.

"*" indicates required fields

Date of last appointment*

Please check you have had a new or follow up appointment in the last 12 months before ordering a repeat prescription.

First Name*

Surname*

Date of Birth*

Email*

Prescription Type*

Oestrogen

Do you need Oestrogen

Oestrogen*

Name of Medication

Dosage

Quantity

Number of

Progesterone

Do you need Progesterone

Please let us know the reason from the following options*

Progesterone*

Name of Medication

Dosage

Quantity

Number of

Testosterone

Do you need Testosterone

Testosterone*

Name of Medication

Dosage

Quantity

Number of

Vaginal oestrogen

Do you need Vaginal Oestrogen

Vaginal oestrogen*

Name of Medication

Dosage

Quantity

Number of

Additional information

Additional information relating to your request that would be helpful. If you need to book a follow up please use our online booking here.

Please try to order all your HRT at the same time to save yourself multiple delivery costs.

Payment*

Confirm*

To process your prescription please tick to confirm that you provide us with consent to automatically take a payment of £37* (or £70 if you’d like to join the Annual Prescription Membership), using the card details we hold on your file. Your prescription will be sent to you in the post.

Disclaimers

OVERVIEW

In order to receive any HRT from us on an ongoing basis, you will need to have an annual follow-up consultation.

If you are prescribed testosterone by us, you will need to have an initial blood test within 3 to 6 months of commencement, followed by an annual blood test if results remain stable.

CHARGES*

There is a £37 fee charged by Newson Health for every prescription written. This charge covers the doctor creating the prescription, which is a legal document for which the doctor who has issued and signed it is responsible.

Annual prescription membership

This is a one-off charge of £70 for a duration of 12 months.

The £70 fee is payable upfront and is non-refundable regardless of the extent of use. This membership can be used for standalone or repeat prescriptions. To fulfil our duty of care to you and to continue to prescribe medication you will need to have a minimum of an annual review with us.

This membership is renewable annually, if you decide to renew for another year please inform us by email info@newsonhealth.co.uk before the expiry date, otherwise the membership will be cancelled. Prescriptions will only be given to cover the period of the membership up to and including expiry date. Medication is charged separately by the dispensing pharmacist, ourselves or CloudRx.

CLOUDRX

To improve the service provided to you, we work with CloudRx (a licensed Pharmacy GPhc number 9011284) to
dispense and dispatch medication on our behalf.

Once your medicine has been prescribed, CloudRx will contact you by email or text to take payment for the medication before it is posted to you.

PRIVACY POLICY

We realise your data is important to you and promise to process it in accordance with our privacy policy

Repeat Prescription Request Form

Please try to order all your HRT at the same time to save yourself multiple delivery costs.

Disclaimers

OVERVIEW

CHARGES*

Annual prescription membership

CLOUDRX

PRIVACY POLICY

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