+123456789012 info@gmail.com
+123456789012 info@gmail.com
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Request a Online Prescription

Please note: Our Practitioners are not able to prescribe controlled substances, addictive medications, Schedule 8 drugs, nicotine pouches, or nicorette gum through this service. View the full list of restricted medications.

Prescription
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Prescription Details
Preferred Consultation Time *

If submitted after 18:00, your request will be processed the next day at first available

Prescription type *
Medication name and dosage *
Reason for medication *
Are you taking other medications? *
Any known allergies? *
Upload Supporting Documents (Optional)

Upload doctor referral, previous imaging reports, or medical records. Accepted formats: PDF, Word (docx), Excel (xlsx), PNG, JPG (Max 5MB per file)

Drag and drop a file here or click the button below to select a file to upload.

I acknowledge that: *
  1. I have read and agree to the Terms and Conditions.
  2. This is not a medical emergency - for emergencies, call 000.
  3. Telehealth has limitations compared to in-person care and may not be appropriate for all conditions.
  4. I will see a doctor face to face if my condition doesn't improve.
  5. All information I have provided is true, accurate and complete to the best of my knowledge.
Personal Details
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Prescription Fee $0001.00
Total to Pay $0001.00 AUD

“Centriva” combines “Cent” (central) and “Riva” (flow of life), Symbolising seamless and adaptive healthcare for everyone.

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