Neurodevelopmental Paediatrics Repeat Prescription Request Form- Alder Hey Hospital

Repeat Prescription Request Form

*Please note* - this is for repeat prescriptions only

Do NOT complete this form if your local GP has agreed to 'shared care'. Please request medications on the shared care agreement through your GP. You will know if your child is on shared care if you have received a letter about this.

Please complete this form to request your child's medication. Complete as much of the information as accurately as possible. A delay will be caused if we need to clarify this information. We aim to send out your prescription to your home address or local pharmacy within 2 weeks of making the request.

You will receive a text message once your script has been dispatched to your requested location. Please allow 2 working days for delivery from this point. Melatonin/Circadin prescriptions may take up to 5 working days as they are dispensed by Alder Hey Pharmacy.