Request a prescription or referral

For patients who are already being treated by us. If you have acute symptoms, please call; at night and at weekends call the out-of-hours medical service on 116 117, in an emergency 112.

Required fields are marked with „Required field“.

Request

Repeat prescription

Referral

First and last name

Date of birth

Insurance

Statutory

Private

Medication (name, strength, pack size) or specialty for the referral

How would you like to receive the prescription or referral?

E-prescription on the health insurance card

Collect from the practice

Phone number for queries

Email (optional)

I consent to the practice processing my details, including health data, to handle my request (Art. 9(2)(a) GDPR). I can withdraw my consent at any time.

Your details are transmitted and stored encrypted and deleted after processing, at the latest after 30 days. More in the Privacy policy.