This service is to request an updated prescription for your child.

You will be prompted to enter the medication name and your child’s details when you check out.

Please note that the specialists at Norwest Kids Specialists clinic work on particular days of the week and therefore there may be a delay in processing your order. Your order will be processed as soon as possible. However you need to request the script at least 2-3 weeks before you run out of medicine.

Prescription Request Form

Child's Name

First

Last

Email*

Date of Birth*

Name of Medication for your Child*

Current Dose*

Child's Current Weight*

Please type the characters*

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