Request a prescription

Repeat prescription guidelines for the menopause and PMS clinic at Chelsea and Westminster site only

  • Accepted requests for off-label drugs only including testosterone, dydrogesterone (duphaston), zoladex, decapeptyl, prostap, crinone, cyclogest
  • A prescription will be written if you have been seen within the last six months and a letter of confirmation will be sent to your registered address and GP
  • If you have not been reviewed within six months, or if your details do not match our records, you may be called for a review before your prescription can be supplied
  • If you live within the NWL or SWL CCG area, you will have to attend the Chelsea and Westminster Hospital pharmacy to collect your prescription
  • If you live outside of the NWL or SWL CCG area, your prescription (FP10) will be posted with a confirmation letter
Typically today’s date
Your mobile or telephone number
This can be found on a previous hospital letter
How often you take the drug
A GnRHa (eg syneral, decapeptly, zoladex, prastap) is not a licenced contraceptive—if you are requesting a drug from this group, you must confirm that you not currently pregnant and using contraception
Complete only if you ticked the third option above
List all known drug allergies—if none, write ‘none’
Please provide a blood pressure reading taken within the last two months—this can be done at home, your GP surgery or a pharmacy
Contributors
simoneoa swagdaddyabs sanabr angusws George Vasilopoulos