Make a medication request (ADHD)

Already a patient with us? Please complete and submit the form below to order a repeat prescription or request a review of your current medication.

It can take 5-7 working days for medication to arrive – please plan ahead to avoid running out. It’s ok to restart medication after a gap, but you might need a brief titration.

Please read our privacy notice before you complete this form

We'll use these details to review your request, check that it's safe to prescribe, and arrange your prescription and supply through our pharmacy partner. Your blood pressure, pulse, weight and medication details will be added to your clinical record. If you're an NHS patient, we use your prescription-charge status only to provide you with requested medication.

Noodle is responsible for your information. We share it only with the providers that help us run this service and with anyone else mentioned above. You have rights over your information, including the right to access or correct it. You can raise a concern with us by email or with the ICO. Read our Privacy Policy.

First Name (required)

Last Name (required)

Email (required)

Contact Number

Date of Birth (required)

Please enter your Date of Birth

Are you a private client or NHS patient? (required)

NHS Patients Only

If you were referred by your GP via Right to Choose, please specify whether you pay for your NHS prescriptions (currently £9.90/item) or if you are exempt

Repeat Prescription, Medication Review Request or Physical Observations? (required)

If you are happy with your current medication and dosage, you can request a repeat prescription. If you are not happy, or are experiencing side effects, please use the option to request a review. Note: If you would like your dosage reviewed we are able to bring your next appointment forward to discuss with your practitioner. Please note that this may require a further private appointment to complete titration at a cost of £140

Physical Health Monitoring

Blood Pressure (Systolic mmHg) (required)

Please provide an up to date Systolic (mmHg) blood pressure reading. This is for your clinical safety.

Blood Pressure (Diastolic mmHg) (required)

Please provide an up to date Diastolic (mmHg) blood pressure reading. This is for your clinical safety.

Pulse (bpm) (required)

Please provide an up date pulse reading. This is for your clinical safety.

Weight (kg) (required)

Please provide your current weight. This is for your clinical safety.

Medication One

Medication Name (required)

If you are taking a combination of medications, please add the other under the Medication Two section below.

Dosage (required)

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

Brand

Do you take a specific brand of medication?

When Do You Take This Medication? (required)

Medication Two

If you are taking a second medication, please add the details below.

Medication Name

Dosage

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

Brand

Do you take a specific brand of the selected medication?

When Do You Take This Medication?

Medication Three

Medication Name

Dosage

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

Brand

Do you take a specific brand of the selected medication?

When Do You Take This Medication?

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Make a medication request (ADHD)