Repeat medication request form | Barnsley Hospital NHS Foundation Trust

Community Paediatrics

Repeat prescription request form

This form is to be used for requesting repeat medication as prescribed by a community paediatrics.

Requests may take 7 working days to process or slightly longer in certain situations. It is recommended that children take regular short melatonin breaks as this can aid the effectiveness of the medication.

A text message will be sent to the registered contact when your child's prescription has been issued.

Telephone requests for medication will not be accepted nor will contacting the team change the time in which these are processed.

Medication request:

Request unavailable

This form is only available for requesting repeat prescriptions of melatonin.

For any other requests, please speak with your consultant or nurse.

Many thanks
Community Paediatrics Team

Patient Details

First we will need to know who is the prescription for?

Surname

First name

Weight (Kgs)

Date of Birth

Postcode

How can we contact you if needed (Telephone number)?

Parent / carer declaration

By ticking this box, you confirm that:

your child has had no known side effect to their medication,
a good sleep routine will continued to be used along side the medication, and
you will collect the medication from the Outpatients Pharmacy at Barnsley Hospital.

Agree