Medication Requests

Order repeat prescriptions or request a review of your current medication here. Please make sure to request medication at least 5-7 days prior to your current supply running out.

Medication Request Form

Name

First Name

Last Name

Contact Number

(###)

###

####

CARE ADHD Client ID Number

This is a 4 digit ID generated on the Pabau system. This number will also be on any reports received from CARE ADHD.

Repeat Prescription or Medication Review Request?

If you are happy with your current medication and dosage, you can request a repeat prescription. If you are not happy, or are experiencing side effects, please use the option to request a review.

Physical Health Monitoring

Blood Pressure (mm/hg)

Please provide an up to date blood pressure reading. This is for your clinical safety.

Pulse (bpm)

Please provide an up date pulse reading. This is for your clinical safety.

Medication One

Medication Name

If you are taking a combination of medications, please add the other under the Medication Two section below.

Dosage (mg)

When Do You Take This Medication?

Medication Two

If you are taking a second medication, please add the details below.

Medication Name

Dosage (mg)

When Do You Take This Medication?

Important Information

Please use this form to request a repeat prescription or a review of your current medications. Please note that it can take 5-7 working days for your medications to arrive so please ensure that you make your request in good time to avoid running out.

Please don’t be alarmed if you do run out temporarily: ADHD medication is not like antibiotics or antidepressants – it is okay to resume after a gap.

This form is for existing clients of CARE ADHD who have been in the care of our medication team.

Medication Requests

Order repeat prescriptions or request a review of your current medication here. Please make sure to request medication at least 5-7 days prior to your current supply running out.

Important Information

Company Information

Your Right to Choose

Useful Links

The Centre for ADHD Research & Excellence Ltd.