Online Prescription Application

Online Prescription Application
Full Name*

First NameLast Name
Date of birth*

DayMonthYear
Address*

Street Address

Street

SuburbState / Province

Post Code
Email*
example@example.com
Phone Number*
Are you an existing Inner North Medical Clinic patient?
Are you a Medicinal Cannabis patient?
Do you have a preferred GP? (Please note, if you wish to have your prescription reviewed by your Inner North GP your request will likely face increased processing time)

IMPORTANT INFO - PLEASE READ
Authority Required Prescriptions - Requests for the following medications require an appointment with a doctor and cannot be accessed through this service:
- S8 medications
- PBS authority prescriptions
- Restricted stimulants (Dexamfetamine, Vyvanse, Concerta, Ritalin)
- Restricted Opiate medications (Endone, Oxycontin, Palexia, etc)
- Restricted Benzodiazepines (Valium, Lorazepam, Temazepam etc)
Specialty Medications - Requests for the following medications require an appointment with a doctor and cannot be accessed through this service:
- Gender affirming therapy
- PrEP
- Ozempic
If you have requested a script for the medications listed in point 1 or 2, you will need to make an appointment in-person.

Script processing can take up to 7 days. For urgent or emergency needs, please seek an alternative service.

All repeat scripts are sent via email to the address on file.
We do not hold any credit card information that is handled by our payment provider, we never see your payment details.
Online scripts are only available for those with a Medicare Number or an Individual Healthcare Identifier (IHI) number.
The cost of this service is $65 and covers up to 6 scripts.
Authority Required Prescriptions Declaration*
I have read the terms regarding Authority Required Prescriptions. These medicines aren’t available through this service.
Medication #1 Name & Dosage*
Medication #2 Name & Dosage
Medication #3 Name & Dosage
Medication #4 Name & Dosage
Medication #5 Name & Dosage
Medication #6 Name & Dosage
I confirm that I have read and agree to the terms and conditions for this service*

Inner North Medical Repeat Script – Max 6 per application

$65.00AUD

Total

$0.00AUD

Pay With Credit Card

Should be Empty:

Online Prescription Application

IMPORTANT INFO - PLEASE READ

Pay With Credit Card