Request form

This request page is only for patients currently attending the menopause, POI or PMS clinic.

  • Repeat prescriptions: You may request a repeat prescription for the following medication only—Testogel 50mg/ml, Tostran gel 2%, Decapeptyl 11.25mg, Zoladex 10.8mg. We will phone you to confirm your prescription is still needed.
  • Reprinted forms for investigations: Please indicate whether you need your request form to be posted or collected from the department. We will only phone you if this needs clarifying.
  • GnRHa injection appointment: If you need an injection urgently in the next 2 weeks and do not have an appointment, please use this form.
  • Appointment changes: This form is not for changes to follow-up appointments—please contact the case manager in the appointment team on 020 3315 3236.

Date of birth   To confirm your identity
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Reason for contact  

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Please allow 5 working days for your request to actioned. We will only contact you on the supplied phone number if we need to clarify your details or request.

  • If you have requested forms to be posted, please allow up to 14 days for these to arrive.
  • If you have requested a replacement radiology form, once this has been ordered you can phone radiology directly to book your appointment.