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Repeat Prescription Request Form

Please note: Repeat prescriptions are only available for patients who have had an appointment at SHE Health within the last 12 months. If this is not the case, please contact the clinic to arrange an appointment before requesting a repeat prescription.

Please complete all sections below to allow us to safely process your request.

Name
Please ensure to include your postcode
Your usual SHE Health Doctor
Since your last consultation with the Clinic, have there been any changes to prescribed medications (including weight loss injections)?
Since your last consultation with the Clinic, have there been any changes to your medical history?
Since your last consultation with the Clinic, have there been any unexpected changes to your usual vaginal bleeding?
Is your registered NHS GP the same as previously recorded with us?
Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera
Declaration
Please note - If any of the information provided raises clinical concerns, we may contact you to arrange an appointment before we can safely issue your prescription.