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1GP – Escript Request Form

Important Notice: This service is for simple, ongoing repeat prescriptions only. It is not suitable for new medications or conditions that require a full medical review.

Please note that we do not prescribe any controlled or Schedule 8 medications, including but not limited to: Diazepam, Endone, any opioids, Lyrica, Stilnox, Zolpidem, codeine-based medications (e.g. Panadeine Forte), benzodiazepines (such as Valium/Diazepam, Temazepam, Oxazepam, Alprazolam), Duromine, Tramadol, Gabapentin, Pregabalin, Seroquel, steroids, Vyvanse, Modafinil, Dexamphetamine, Ritalin, Concerta, Sofradex eardrops, and Roaccutane.

If you require any of the above medications, please book a telehealth consultation instead. Escripts will cost $29 for two scripts.

    Your Details

    Full Name (First and Last)

    Gender

    Mobile Number

    Email Address

    Date of Birth

    Residential Address

    Suburb

    State

    Postcode

    Medication Name

    What health condition is this medication intended to manage?

    Has this medicine been previously prescribed by your usual GP or healthcare provider?

    How long have you been using this medication?