Medical Card / Doctor Visit repeat prescription request Please allow 5 working days for the prescription to be sent to your pharmacy. Name * First Name Last Name Date of Birth (DD/MM/YYYY) * Phone * (###) ### #### Medical Card Number * Medical Card Expiry Date * Medications * Nominated Pharmacy * I ACKNOWLEDGE THAT IT TAKES UP TO 5 WORKING DAYS (EXCLUDING WEEKENDS) TO PROCESS REPEAT PRESCRIPTION REQUEST Your request has been successfully submitted.
