Request a prescription

Repeat prescription guidelines for the menopause and PMS clinic at Chelsea and Westminster site only

  • Accepted requests for off-label drugs only including testosterone, dydrogesterone (duphaston), zoladex, decapeptyl, prostap, crinone, cyclogest
  • A prescription will be written if you have been seen within the last six months and a letter of confirmation will be sent to your registered address and GP
  • If you have not been reviewed within six months, or if your details do not match our records, you may be called for a review before your prescription can be supplied
  • If you live within the NWL or SWL CCG area, you will have to attend the Chelsea and Westminster Hospital pharmacy to collect your prescription
  • If you live outside of the NWL or SWL CCG area, your prescription (FP10) will be posted with a confirmation letter
Request date   Typically today’s date
/ /  
Date of birth  
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Date of last consultation  
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Date of last supplied prescription  
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GnRHa drugs   A GnRHa (eg syneral, decapeptly, zoladex, prastap) is not a licenced contraceptive—if you are requesting a drug from this group, you must confirm that you not currently pregnant and using contraception

Have you ever had a heart attack, stroke (CVA/TIA) or blood clot (VTE/DVT)?  

Have you ever had breast cancer?