Please complete the form below to order a repeat prescription. We should respond within 24 hours Monday to Friday. If you do not hear back from us something may have gone wrong - please phone us on 09 489 6871. NameThis field is for validation purposes and should be left unchanged.Title Mr Mst Mrs Ms Miss Dr Name*Date of Birth* DD slash MM slash YYYY Contact Number*Email* Preferred DoctorPreferred DoctorDr Nadeem AhmadDr Rasha AltaieDr Dan GoslingDr Jo KoppensDr Brian SloanDr Tahira MalikDr Lucy LuNo Preferred DoctorPreferred Pharmacy*Repeat Prescription:*CAPTCHA
