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	REQUEST A REPEAT PRESCRIPTION   Please enter your details to request a repeat prescription.  Items marked () are mandatory.   * Childs First Name * Childs Family Name * Date of Birth -  Day / Month / Year 12345678910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember/ 198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Gender MaleFemale Apartment or Unit * Street Number * Street Name * Suburb * Postcode * Salutation MrsMrMissMsDr * First Name * Family Name * email address email address confirm * Phone Number Preferred Second phone number Paediatrician PaediatricianDr McCarthyDr SelikowitzDr SaltmanDr Yeoh Ritalin Short-acting Tablets Ritalin Short-acting Tablets Ritalin Tabs 10mg Please select number per day One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve  Ritalin LA Capsules Ritalin LA Capsules Ritalin LA Capsules Strength 10 mg20 mg30 mg40 mg Ritalin LA Capsules No per Day One per dayTwo per day              Ritalin LA Caps 2nd Strength             2nd Strength 10 mg2nd Strength 20 mg2nd Strength 30 mg2nd Strength 40 mg              Ritalin Caps 2nd No per Day             One per dayTwo per day Vyvanse Capsules Vyvanse Capsules Vyvanse Capsules Strength 30 mg50 mg70 mg Vyvanse Capsules No per Day One per dayTwo per day             Vyvanse Caps 2nd Strength            30 mg50 mg70 mg             Vyvanse Caps 2nd No per day            One per dayTwo per day Concerta Tablets Concerta Tablets Concerta Strength 18 mg27 mg36 mg54 mg Concerta No per Day One per dayTwo per day             Concerta 2nd Strength            2nd Strength 18 mg2nd Strength 27 mg2nd Strength 36 mg2nd Strength 54 mg             Concerta 2nd Strength No per Day            One per dayTwo per day Dexamphetamine Short-acting Tablets Dexamphetamine Short-acting Tablets Dexamphetamine Tabs No per Day One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve  Dexamphetamine Compounded Caps Dexamphetamine Compounded Caps Dexamphetamine Caps Strength 5 mg7.5 mg10 mg Dexamphetamine Caps No per day One per dayTwo per day Strattera Capsules Strattera Capsules Strattera Capsules Strength 10 mg 18 mg25 mg40 mg60 mg80 mg Strattera Capsules No per day OneTwo           Strattera Caps 2nd Strength          18 mg27 mg36 mg54 mg72 mg           Strattera Caps 2nd No per day          OneTwo Catapres (clonidine) Tablets Catapres (clonidine) Tablets Melatonin Prolonged-release Tablets Melatonin Prolonged-release Tablets Melatonin Tablets No per day One per dayTwo per dayThree per day Melatonin Compounded Capsule Melatonin Compounded Capsule Melatonin Comp Caps Strength 2 mg3 mg4 mg5 mg Melatonin Comp Caps No per day One per dayTwo per dayThree per day Risperdal (Risperidone) Tabs Risperdal (Risperidone) Tabs Risperdal Tabs Strength 0.5 mg1 mg2 mg Risperdal Tabs No per day One per dayTwo per dayThree per dayFour per day             Risperdal Tabs 2nd Strength            0.5 mg1 mg2 mg             Risperdal Tabs 2nd No per day            One per dayTwo per dayThree per dayFour per day Other Medication Other Medication Other Medication Name Other Medication Strength Other Medication No per day Second Additional Medication (please specify) Other Medication Other Medication Name Other Medication Strength Other Medication No per day    ©  2005 - 2017 Sydney Developmental Clinic   Web design by Net Age