St George Oncology Repeat prescription request

Prescription request
This is to request a repeat prescription for a medication that has been previously prescribed by a doctor at St George Oncology Associates or Southside Cancer Care.

All other medications should be requested from your General Practitioner.

Please note this form CANNOT be used for narcotics

Eg. Morphine, MS contin, Oxycontin, endone

These medications require an appointment with your doctor.
To request a repeat prescription you must be a current patient of St George Oncology or Southside Cancer Care and have attended an appointment within the past 12 months. Are you currently a patient at one of these practices?*

St George Oncology AssociatesSouthside Cancer CareNo
As you have answered NO above, you are not able to request a

prescription using this form and will need to contact the rooms on

(02) 9553 9220 to make an appointment with one of the doctors.
How would you like your prescription delivered? Prescriptions cannot be posted as they frequently go missing. The cost for a script provided outside of an appointment time is $25.*

escript (sent to your phone or email)Email prescription to my pharmacy - enter pharmacy contact details belowPick up script from St George OncologyPick up script from Southside Cancer Care
Please note: Many pharmacies will not accept emailed prescriptions from patients and will request that St George Oncology email directly to the pharmacy.
First Name*
Last Name*
Date of Birth*

DayMonthYear
Your Preferred Phone Number*
Your Postal Address*

Street Address

Street Address Line 2

CityState

Post Code
Your email address:*
Pharmacy details
Pharmacy name*
Pharmacy address

Street Address

Street Address Line 2

CityState

Post Code
Pharmacy email address - must be provided if you would like prescription emailed*
Prescription details
Medication name*
Reminder: we can not provide prescriptions for narcotic or strong pain killers without an appointment
Medication dosage*
How many times per day do you take this medication? Daily, twice per day, at night etc*
Who is your usual doctor?*

Dr Patricia BastickDr Tracey DunlopDr Carole HarrisDr Lyn Ley LamDr Fernando RoncolatoDr David Thomas
Thank you for submitting your repeat prescription request. One of our team will be in touch to collect payment details.

Repeat prescriptions without an appointment require prepayment of $25.

Please note that in some circumstances it is not safe to simply provided repeat prescriptions and you may require an appointment with the doctor to review your medication.
Should be Empty:

Prescription request

Pharmacy details

Prescription details