Prescription Request

For Members Use Only

Please note: prescription requests can take up to 48 hours to be processed

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Patient's Information


Patient's Information

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Specialist Hormone Prescription Request

For patients on our Specialist Hormone Service

Before completing this form, to avoid delay, please check when your review is due. Your review date will be listed on your last prescription which will have been emailed to you when issued. Where appropriate, your clinician may have authorised a repeat, repeat authorisation is highlighted in the prescription. If this is the case, you can contact the pharmacy directly if you are running out before your next review.

By Road

Levitas Clinic Guildford is located on London Road (A3100), opposite Stoke Park. There is free off site parking directly outside Elmdon House on London Road. Disabled parking is available on site. Turn into Elmdon House and follow the signs to the front entrance.

By Train

London Road Train Station is a short 10 minute walk from Levitas Clinic Guildford. Guildford Main Station is a 20 minute walk from Levitas Clinic Guildford. Buses are available.

Levitas Clinic Guildford London Locations:


21 Woodstock Street, Mayfair,

London W1c 2AP

Coming soon


58 Molton St, Mayfair,

London, W1K 5SL

Coming soon


23 Harley St, Marylebone,

London, W1G 9QY

Coming soon