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Order a repeat prescription

For medicines that you take long-term and that we have already prescribed for you. We only prescribe new medicines after you have talked to your doctor.

Please fill in all fields that are not marked as ‘optional’.

Part 1 of 5 Your details

Please write it exactly as it appears on your health insurance card.

First name

Last name

Date of birth

Day.Month.Year, for example 07.03.1952

Phone number for queries

With the area code – ideally a number on which you can be reached during the day.

How are you insured?

statutory health insurance (gesetzlich) private health insurance (privat)

Part 2 of 5 Your medicines

It is best to copy what is written on the pack. Up to three medicines at a time.

Medicine 1

Name of the medicine

Strength (if known)

for example 5 mg

Quantity or pack size (if known)

for example 100 tablets or N3

Add a second medicine

Medicine 2 (optional)

Name of the medicine

Strength (if known)

for example 5 mg

Quantity or pack size (if known)

for example 100 tablets or N3

Add a third medicine

Medicine 3 (optional)

Name of the medicine

Strength (if known)

for example 5 mg

Quantity or pack size (if known)

for example 100 tablets or N3

Part 3 of 5 How would you like to receive the prescription?

E-prescription via my health insurance card The pharmacy retrieves it with your card – at any pharmacy. You do not need a paper copy. Paper prescription – I will collect it at the practice At the reception desk, during opening hours.

Part 4 of 5 Anything else? (optional)

Preferred doctor

Message to the practice

For example, if something has changed in the way you take your medicine.

Part 5 of 5 Confirmation

I take these medicines regularly. They have already been prescribed for me at this practice.

Not for emergencies. We do not read online requests straight away.

We only use your information to process your request. Privacy notice (opens a new window)

Order a repeat prescription

Please check your details

Is everything correct?