Prescription Fees

Fees are normally charged for scripts requested outside of appointments.

Script Request Form

Scripts are to be provided as eScripts wherever possible

Patient's Name

PLEASE COMPLETE SEPARATE SCRIPT REQUEST FORMS FOR EACH SCRIPT

First Name

Last Name

Patient's Date of Birth

YYYY

By providing your email, you are agreeing to our privacy policy regarding email contact. Prosper Paediatrics uses patients' email addresses to contact them and provision of necessary information to them. Patient emails will not be used for marketing purposes and are stored securely and kept confidential. Email is not a completely secure form of communication, but we will endeavour to limit private and clinical information to protect your privacy. See our privacy policy for more information.

Medication Name

Medication Strength

Quantity Left

Dose your child is taking per day

Time of med dose (for Medication Agreement Form)

Hour

Minute

Second

Date when you will have no medication left for the prescribed dose?

YYYY

Is this script urgent?

Do you require it within the next 18 business hours?

Yes, and I understand there is an extra charge.

No.

Current Blood Pressure/ Height/ Weight

unless you know that your doctor does not normally require this

Any other information for your doctor

any additional information your doctor needs to know about this script request/ medication.

Further script requests to be submitted today

Let us know if you are going to submit additional script requests today. Your doctor can charge a lower fee for additional scripts if they can issue them at the same time and they are billed together in one invoice.

before or instead of issuing the script, your paediatrician or their locum, as per their professional, clinical and regulatory responsibilities,

may require a face-to-face appointment to review your child's progress, medication side effects or efficacy before issuing a script at any time.
may require a face-to-face review, usually a month, after beginning a new medication or dosage change.
will require, in the case of Authority Prescriptions, that your child is reviewed with a physical check-up face to face at least every six months and may decline the script request until your child can attend a review appointment. Please contact the rooms to arrange an appointment if not already booked.
may agree that a child from a regional, rural or remote area may have their medication reviewed over video but also require a physical check with and report from a more local health provider such as a GP.
may issue an interim script, if possible, once you have booked a review appointment and require that your child attend that appointment before any further prescription is made.
will require your child to have a current referral to their care for this matter.
may decline to renew the prescription.

Invoice due date:

If your child's next appointment is currently scheduled within one month,
- your payment of this invoiced amount is due no later than the day of that scheduled appointment.
If no appointment is currently scheduled within the next month,
- your payment is due within 7 days of the issue of this invoice.
- please phone the rooms to put through the payment or make a bank transfer.
If the currently scheduled next appointment is cancelled or rescheduled to a later date,
- your payment is due when you cancel or reschedule this appointment.

If your doctor, at their discretion, declines to issue the script or waives the fee,

any script fees you have paid will be changed to an Account Deposit and applied to contribute to the payment of the fee for your child's next appointment unless there are no further appointments scheduled.
any unpaid invoice will be credited.

Prescription Fees

Script Request Form

before or instead of issuing the script, your paediatrician or their locum,​ ​as per their professional, clinical and regulatory responsibilities,

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before or instead of issuing the script, your paediatrician or their locum, as per their professional, clinical and regulatory responsibilities,