Script / Referral - only for renewal
Please note you can only use this form if you have had a face to face consultation with one of our doctors in the past 3 months. Your regular GP will call you for a telehealth appointment within the next 2 working days. Please note Dr Galal Tadros and Dr Russell Bock will not be using this form - their patients must make an appointment for all script/referral requests. Any request for Dr Jessica Khouri will be forwarded to another Doctor while she is away on leave.

We will ignore this request if :
- You haven't had a face to face consult in the past 3 months
- You are asking for a new referral or prescription
- Any prescription for pain killers / drugs of addiction
Please make an appointment through our website to see your doctor face to face / telehealth.
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First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Regular GP *
Last Visit *
MM
/
DD
/
YYYY
Medication Name for Prescription/Specialist Name for Referral
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