Prescription Refill Service

1
Have the medicine(s) been prescribed by Bridging Healthcare in the past?* This field is required.
YESNO
2
Have you had a review with Bridging Healthcare in the last six (6) months?* This field is required.
YESNO
3
Are you having any side effects relating to your requested medicine(s)?* This field is required.
YESNO
4
I confirm the medicines requested are for the treatment or prevention of a long-term health condition.* This field is required.For example, high blood pressure, HIV PreP or diabetes.
YESNO
5
I understand that medicines that may cause addiction or dependency are not eligible for this service.* This field is required. (e.g. valium, panadeine forte, medicinal cannabis)
YESNO
6
Not Eligible for Prescription Refill

We apologise, but you are not eligible for the precription refill service.
If you would like to book in for a review with Bridging Healthcare please follow this link.
7
Please Provide Your Prescription Details* This field is required.
First Name
Surname
Please enter your email
Mobile phone
8
Date of Birth* This field is required.
Date of Birth
Day
Month
Year
9
Do you want your prescription sent via SMS or Email?* This field is required.
SMS
Email
10
What Medicines Are Required?
Medicine
Strength
Medicine
Strength
Medicine
Strength
Medicine
Strength
11
My Prescriptions* This field is required.
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costAUD
Prescription RefillSelect this option to complete your request.
$15.00AUDEdit
Back
PreP 3-Monthly MonitoringSelect this option if requesting a PreP script. A pathology test form will be sent, which must be completed within 7 days of the script being issued.
$10.00AUDEdit
Back
Total cost $0.00AUD
First Name
Last Name
Should be Empty:

Not Eligible for Prescription Refill