Manse Medical's Online Script Request Form

Manse Medical's Online Script Request

Patient Information

First Name *

Surname *

Date of Birth *

Email Address *

Mobile Number *

Doctor and Script Information

Name of Medication *

Dosage *

Type of Script *

Authority Script $ 50.00Standard Script $ 30.00

Please note that the scripts are provided as e-scripts for convenience.

Total Amount (Including EFTPOS processing fee)

Enter credit card details *

Please complete the below: *

I confirm that my mobile number is correctI consent for Manse Medical to send marketing communication that may be relevant to me such as clinic updates, promotions and service information.I consent for Manse Medical to use the data provided in this questionnaire in an unidentifiable manner for research and development purposes.

And we're done! Your responses will be emailed to you and Manse Medical.

Terms and Conditions:

This service is only available to existing patients of our clinic.
We only provide repeat prescriptions for medications you have previously obtained from your doctor.
You can request multiple medications in a single request.
We do not provide repeat prescriptions for addictive medications, including benzodiazepines and opiates.
Each request is individually assessed by your doctor, who will approve or decline it based on clinical grounds. If declined, you will be advised to schedule an appointment
Requests are processed only by your regular doctor at the clinic. If your regular doctor is on leave, you must make an appointment with another doctor to obtain your prescription.
Your doctor may also decline a repeat prescription if you have not been seen recently, as a clinical review may be required before continuing the medication.
A fee applies to each prescription request. The exact fee will depend on the type of prescription and will be provided to you before you submit the form.
The fee associated with each request is payable when the request is submitted. If your request is declined, our staff will contact you and issue a refund within several business days.
Please allow several business days for repeat prescription requests to be processed.
Prescriptions are sent as electronic prescriptions (e-scripts) by default, which are sent directly to your mobile number via SMS.
If you require a paper script (hard copy) to collect from the clinic or have posted to you, please contact our administration team by email or phone instead of submitting your request. Additional fees may apply for printed or posted scripts.

Important Reminders

This service is not for urgent medication needs.
If you are out of your medication, please submit your request several days before you are due to run out.
If you are experiencing new symptoms, side effects, or need to change your medication, please book an appointment instead of using this service.