Prescription Request Form - Dr Claire Taylor

Prescription Request Form

Dr Claire Taylor Clinic
Private Prescription Information

Dr. Taylor can prescribe and monitor medication as part of a comprehensive, holistic package of care. This means that patients will be responsible for the following costs:

- A review appointment to assess suitability, safety, and clinical response. The minimum review interval will be determined by Dr. Taylor.
- A prescription processing fee of £25, which applies per prescription form (not per item) and covers administrative, clinical, legal, and governance responsibilities
- The cost of the medication, payable directly to the dispensing pharmacy. Dr. Taylor will discuss your pharmacy options with you at your consultation.

Please note: this is the only way to request medication from Dr. Taylor.

If you email a request without completing this form, your prescription will not be processed.

Any decision to prescribe medication will always be made as part of a shared, individualised treatment plan, with patient safety as the highest priority.

For clinical governance reasons Dr Taylor cannot prescribe longer than 3 months of medication unless it is LDN, as Dicksons dispense it monthly.

For safety and continuity of care, Dr. Taylor is required to contact your NHS GP when prescribing. This ensures appropriate communication with your NHS GP, who may also be involved in prescribing medication.

Shared Care/GP Prescribing

Shared care with your NHS GP may be possible, but this is entirely at their discretion. We cannot request or require any NHS GP to take over prescribing, and they are under no obligation to do so. If you wish to explore shared care, you are welcome to book an appointment with your GP to discuss this further.
Patient's Name*

First NameLast Name
Patient's Age*
Patient's Date of Birth*

DayMonthYear
Date
Patient Phone Number
Patient's Email*
example@example.com
Patient's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Prescribed Medication requested details*

	Name of Medication	Current Dose (what MG etc)	How often? (twice daily etc)	Quantity (Max 3 months)
1
2
3
4
5
6
7
8
9
10

Additional information. Please let us know here anything else we need to know.

Please select preferred pharmacy*

Pharmacierge- Electronic prescribing, home delivery and repeat prescriptionsDicksons - LDN prescriptions and home delivery - please note there is no repeat facility for other prescriptions.Roseway Labs- Home delivery and compounding
Please note all Low dose Naltrexone prescriptions are processed by Dickson's pharmacy unless otherwise discussed. If you would like all your medications through Dicksons please tick the Dicksons box. If you would like LDN from Dicksons and anything else from Pharmacierge please just tick the Pharmacierge box. The main difference is that repeat prescribing is available from Pharmacierge where Dr Taylor sees it as appropriate. This means that you do not have to always come back to her for a repeat request.

Roseway labs can acommodate compounding medications. Please note they do charge for this service. Please contact Roseways directly if you have a need for compounding and state clearly on this form what compounding you require.

Pharmacy contact details

Dickson's Chemist: Phone 0141 404 6545 Email info@dicksonchemist.co.uk

Pharmacierge: Phone 0207 631 1269 Email pharmacist@pharmacierge.com

Roseway Labs: Phone 0333 050 4030 Email info@rosewaylabs.com

My Products*
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Prescription Fee
£25.00

Total

£0.00
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