CBD West Medical Centre – Script Renewal & Referral Requests

Step 1 of 3

Important Information

CBD West Medical Centre is pleased to offer our patients the convenience of ordering your repeat prescription medication or a referral to a specialist via our website or clinic App. We'll need to ask you some questions about yourself, as well as the details of your request. You will need to be an existing patient of the clinic to use this service. Scripts & referrals requested via our online ordering system may take between 1-7 working days to be returned to you. If you require delivery in a shorter timeframe, please book an appointment with your regular doctor. There is a charge associated with this service of $25.00. This charge covers the time spent by our admin staff & doctors to prepare your request. The clinic reserves the right to refuse any request they may deem inappropriate to complete. In such a circumstance your fee will be reimbursed immediately and the clinic may contact you to follow up.

Personal Information
First Name*
Last Name*
DOB*
Email*
Phone*

Script/Referral Information
Doctor*
Request type*
- Script renewal
- Referral
Service Fee*
Price: $ 25.00
Script/Referral details*
Enter the details of your requested prescription medication or referral request below. Ensure all details are correct before submitting.
Collection method*
- Collect at clinic
- Mail out
- Fax direct to pharmacist
If mail out is selected, the mailing address on file at the clinic for the patient will be used.

If you choose to have your script faxed directly to your pharmacist, you will still be required to present the original prescription before you collect your medication.
Pharmacist's Fax Number*
Fax Direct to Pharmacist Fee
Price: $ 1.50
Mail Out Fee
Price: $ 1.50

Payment Information
Billing Address*
Street Address Address Line 2 Suburb State Post Code Country
Payment Methods*
- Credit Card
- PayPal
Credit Card*

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total Cost
$ 0.00
Terms and Conditions

If you are an existing and regular patient at CBD West Medical Centre, we can offer you the convenience of requesting your repeat prescription medication, or a re-referral to a specialist, via our website or clinic app.

We will require some general information about yourself, as well as the specific details of your request. In order to qualify you will need to be an existing patient of the clinic and have been seen in the clinic within the last 12 months.

Our goal is to action requests for prescriptions and referrals via this online ordering system by the next business day, however it may take between 1-7 working days to be returned to you. This will depend upon whether you elected to have it collected, faxed or posted.

If you require such services within a shorter timeframe, you will need to attend the clinic for a consultation with your doctor.

The charge for a repeat prescription or re-referral is $25.

This charge reimburses the time spent by administrative staff and doctors preparing your requested option.

CBD West Medical Centre reserves the right to decline any request deemed inappropriate. In such a circumstance your fee will be reimbursed immediately and the clinic may contact you for followup.
Acceptance of Terms & Conditions*
- Yes I accept

CBD West Medical Centre – Script Renewal & Referral Requests

Step 1 of 3

Important Information

Personal Information

Script/Referral Information

Payment Information

Terms and Conditions