Prescription request

Please submit the following information so we may process your prescription refill.

Please note this service is only available for current FirstMed patients and all refills are done at the doctors discretion. If you are not a premium plan holder we do require a small fee to cover processing time which will be needed to be paid beforehand.

1. Prescription Refill request

Are you a Premium plan holder?*
- Yes
- No
I am a....*
Are you a patient of FirstMed?*
- Yes
- No
Family name*
Last
Given name*
First
Phone*
Email*
Date of birth*
YYYY slash MM slash DD
Passport No & Citizenship*

e.g. 2373485327 - USA
TAJ number if available
Was the medication requested prescribed at FirstMed before?*
- Yes
- No
Medications requested to be refilled
Please use all four columns. To add additional prescriptions press the '+' after "Frequency'*
Brand, or active medication Last lab tests [YYYY-MM-DD] Dosage Frequency Duration requested

This form must include: the medication name, or active ingredient for non-Hungarian medication, date when the original prescription was written or retested for, dosage, and the frequency.
How would you like the prescription prepared?
e-prescriptions are available for TAJ card holders and through certain pharmacies that may allow with a foreign passport, please check with your local pharmacy first as FirstMed does not know which allow this. All paper prescriptions will be available at FirstMed reception after the prescription is ready.
Is medical note/paper prescription is needed for insurance?
- Yes
- No
Additional information

Use this space to provide additional information about your request, e.g. duration of medication, changes in dosage, number of boxes you'd like, etc. Please be clear as to which medication is being referenced.
Please call the clinic for an appointment to speak with a doctor about your medication: +36 1 224 9090
CAPTCHA

Prescription request

1. Prescription Refill request

Medications requested to be refilled

Please call the clinic for an appointment to speak with a doctor about your medication: +36 1 224 9090

Main Pages

Location

Clinic Hours

Blog

Brand, or active medication	Last lab tests [YYYY-MM-DD]	Dosage	Frequency	Duration requested