Prescription request form
Please complete this form to request a prescription from a Leading Steps Paediatrician. The paediatrician must have previously seen your child, and a future appointment must already be booked. This service is intended for unexpected prescription needs. For stimulant medications used in ADHD, the previous prescription must be due to expire within the month (government requirement). By using this service, you consent to a video consultation if required, to clarify any details regarding your child’s clinical progress. We aim to process requests within 2–5 business days. In most cases, the paediatrician will provide a prescription sufficient to last until the next scheduled review appointment. A $30 fee applies for this service. Occasionally, further review may be required, and a prescription may not be issued. We receive frequent requests for repeat prescriptions when repeats are still available. These are stored electronically and can be accessed by your pharmacist, even if they are not visible on your phone. Please check with your pharmacist first to confirm whether repeats remain. If a request is made and repeats are still available, a $10 administrative fee may apply.
Patients Full Name
*
First Name
Last Name
Child's date of birth
-
Day
-
Month
Year
Date
Parents name
*
Phone Number
*
Format: 000 000 0000.
Email
example@example.com
Paediatrician
Please Select
Dr Dylan Wilson
Dr Naomi Chellew
Dr Stephen Ansley
Dr Garth Small
Dr Melanie Aldridge
Dr Glenn Harte
Dr Scott Blundell
Dr Catherine Stewart
Dr Syed Fasihullah
Dr Mike Wong
Dr Sarah Taylor
Dr Amy Whittaker
Dr Tim Pont
Dr David Pincus
Dr Victoria Matheson
Dr Ananya Patheja
Dr Natasha Russell
Dr Sophia Knoblanche
Dr Prudence Verry
Prof Lionel Lubitz
Dr Ravi Bala
Dr Elize O'Reilly
Dr Jensen
Unknown (can not recall)
Prescription required
*
Dose
*
Frequency medication is taken
*
Current weight and height (if known)
Comments
0/150
Please double check that you do not have repeats at the chemist.
.
Should be Empty: