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Request a prescription or referral

neurology

important information

You can use this form to request your previously prescribed prescriptions at any time.

Reorder or request a transfer.

Attention: New prescriptions cannot be ordered via this form, as a tender for a

A doctor's visit is required for a prescription. A doctor's visit is also necessary for certain referrals.

In this case, please make an appointment first.

The insurance card must have already been scanned in the current quarter or presented upon collection.

The ordered prescriptions/referrals can be picked up at the health center on the next working day.

General Information

Contact options

Please provide a way to contact you so that we can reach you if we have any questions.

What would you like to request?

Vielen Dank!

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