Repeat Prescription Form for ADHD Medication

This form is for patients who have completed commencement and titration of ADHD medication with Midlands ADHD Clinic or Malvern Hills Private Practice.

You are welcome to order all repeat prescriptions via this form. Please note, the type and dose must match your previous prescription. For a prescription change please call 01684 647 500 to book a review consultation.

Midlands ADHD Clinic. Repeat Prescription Ordering Form

Midlands ADHD Clinic. Repeat Prescription Ordering Form

Patient Information

Please provide the same email address as your original referral and Health Screen.

Medication Information

What is the name of the Prescriber you most recently met with?
If you wish to change your prescription please telephone 01684 647 500 to book a review consultation.
Where would you like your prescription sent?

Delivery Information

Dispensing Pharmacy
Unless specified otherwise above, your medication will be ordered from Cloud RX. Due to regulations we can only provide one months supply.

Fee
There is a fee of £30 to order a prescription with our service (+£10 optional faster delivery of script to pharmacy).

Delivery Time
Due to current legislation, your paper prescription has to be posted to the pharmacy prior to any medication being released.  This means delivery time frames are approximately 8 working days from ordering through to receiving medication. This may be shorter if we are sending the paper prescription directly to your home. 

Payment Information

We charge £30 for a repeat prescription. This will be taken from the card attached to your account. We will text you if payment is declined or your card details are not stored.
Cloud RX require us to post your paper prescription using Royal Mail. The above includes first class postage. However Royal Mail time frames can vary greatly from 2 - 6 days. We recommend faster tracked delivery is added to your fee.
Faster delivery option can be chosen for Cloud RX dispensing or sending the prescription to your home.

Expectations of Time Frame

Please confirm: