Repeat medication

Fill in the information

Repeat prescriptions can be requested 24 hours a day and only via the website. Fill in all the requested fields and click send. Your prescription will be ready at the pharmacy after 5 working days. So, make sure you request your repeat medication in time.

Note: you must be under care at Psychiatrie Noord to be eligible for a repeat prescription.

Has it been more than six months since the last medication? We advise you to schedule an appointment for a medication check.

Client

Name*

Date of birth*

Zip code*

House number*

Address*

City*

Email address*

Pharmacy

Name Pharmacy*

Zip code*

House number*

Address*

City*

Medication

Name medicine

Strength (mg/ml) medicine

Application (tablet, capsule, etc.)

Medicine dosage

Were there any changes in your (self)medication since the previous prescription?

Remarks or questions

Name medicine

Strength (mg/ml) medicine

Application (tablet, capsule, etc.)

Medicine dosage

Were there any changes in your (self)medication since the previous prescription?

Remarks or questions

Name medicine

Strength (mg/ml) medicine

Application (tablet, capsule, etc.)

Medicine dosage

Were there any changes in your (self)medication since the previous prescription?

Remarks or questions

Name medicine

Strength (mg/ml) medicine

Application (tablet, capsule, etc.)

Medicine dosage

Were there any changes in your (self)medication since the previous prescription?

Remarks or questions

Name medicine

Strength (mg/ml) medicine

Application (tablet, capsule, etc.)

Medicine dosage

Were there any changes in your (self)medication since the previous prescription?

Remarks or questions

Add medication

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