Request Form

First Name *

Last Name *

Email Address *

Date of Birth *Press "enter" once date is chosen.

Please choose option required *

Script Token Screening Questions

Which option applies to your situation? *

I am unable to find or access a script token that was issued by Dr LawI still have my original script token, but it doesn't work anymore

Prescription Expiry

Stimulant prescriptions expire after 6 months, even if the script has repeats left.

Other prescriptions expire after 12 months, even if the script has repeats left.

Is it possible your script has expired? *

Yes - it has expiredNo - it has not expiredI don't know

You need a new prescription, as expired scripts cannot be reactivated.

Please return to the first page of this form and select 'Prescription Request' instead.

You may be eligible. Please proceed to the next question.

Has a pharmacy dispensed your medications using the original script token sent to your by Dr Law? *

YesNoI don't remember

The Original eScript Token is Valid for a Single Use Only

Once an eScript token has been used, it is no longer valid and cannot be used again, even if the script has repeats available.

After dispensing medication via an e-script, the pharmacy generates a new script token for the next repeat. This continues for each repeat until all are dispensed or the script expires.

What to Do

You have 3 options:

Visit your pharmacy to get your next repeat dispensed. If needed, check the label on your medication or your My Health Record for dispensing information to remind you of the pharmacy you visited.
Ask your pharmacy to send the new script token to your phone—this is ideal if you want to use a different pharmacy next time.
If the first two options fail and your script hasn't expired, submit this request form to request a new token to be sent to you by Dr Law

Click the 'Next' button below if you wish to proceed.

Fee Information

Script Token Resend Fee Information

First request per calendar year: no charge.
Subsequent requests per calendar year: a fee applies for each occasion. The fee is $11 (includes GST) per occasion.
This fee has been introduced because it takes considerable admin and doctor time to action these requests, and some individuals request this multiple times per year.
No Medicare rebate applies

Please confirm you are aware of the fee to re-send e-Script tokens *

Yes, I am aware of the fee and would like to proceedI do not wish to pay the fee, so I will ask the pharmacy to re-send the token instead

Please contact your pharmacy.

There is no need to submit the form as you do not wish to proceed.

Please specify which prescription tokens need to be sent to you again *

Additional comments (optional)

Eligibility Questions

Have you attended an appointment in the last 6-7 months? *

YesNo - my appointment was cancelled by Dr KateNo

Great! You may be eligible. Please proceed to the next question.

You May Not Be Eligible

If you have not attended an appointment in the past 6-7 months, you will require an appointment for your prescription or document. Please email admin@drkatelaw.com.au to arrange your appointment.

If you would like your request to be considered anyway, or your request was discussed with Dr Law at your last appointment, please complete the rest of the form. While we cannot guarantee your request will be approved, we will consider your request and advise you of the outcome as soon as possible.

Please briefly explain why you wish to go ahead. Please mention if this was approved in advance: *

Did you cancel, reschedule or miss your most recent appointment? *

YesNo

Great! You may be eligible. Please proceed to the next question.

You Are Not Eligible

Because you cancelled, rescheduled or missed your last appointment, you will need to attend an appointment for a prescription/document or to discuss an update/question. Please do not proceed with submitting your form. Instead, please email admin@drkatelaw.com.au to arrange your appointment.

Enquiry or Update Conditions

Please confirm you are aware of the following conditions before you proceed:

This is not related to an urgent issue or an emergency *

Please allow up to 7 business days for admin to process your update/question and notify Dr Law. Further time is then required for Dr Law to respond (if a response is applicable) *

Electronic communication is not suitable for detailed updates or questions. You will be advised if an appointment is required once your form has been processed. *

Due to time constraints, personal replies cannot be sent for every question or udpate. Dr Law may choose to discuss your update/question at your next appointment for this reason. *

Responses containing private information may be sent via a password-protected PDF to protect your privacy. *

Enquiry/Update Details

Please briefly describe your update in 2-3 sentences *Maximum 600 characters

Please briefly describe your question in 2-3 sentences *Maximum 600 characters

Do you wish to receive a response before your next appointment? *

No - this can wait until my next appointmentYes - I would prefer a response. I am aware that a response is not guaranteed

If Dr Law advises an appointment is needed to discuss your enquiry in more detail, which of the following appointment options suit your preferences? You can select multiple options *

Please specify any other appointment or waitlist preferences (optional)

Are you requesting a prescription for stimulant medications (Vyvanse, Dexamfetamine, Ritalin/Methylphenidate, Concerta or Ritalin LA)? *

YesNo

You may be eligible to submit a prescription request. Please answer the below questions to check your eligibility futher.

Please proceed to the next section.

Are you currently happy with your stimulant medication dose/plan? *

Yes, it is going well and I do not need any changesNo, I want to make some changes

Great! You may be eligible. Please read the information below and then proceed to the next question.

Not Eligible for Stimulant Prescription Request

Because you would like to change your stimulant medication plan, an appointment is required. The stimulant prescription will be declined if you proceed with submitting this form. We can organise other prescriptions if required, or we can wait until your appointment.

If you are happy to continue the current plan for now and delay reviewing the dose/plan until your next appointment, please specify the issue below to help Dr Law decide whether to approve your script request.

Then, read the script fee information and proceed to the next question.

To request an appointment, please return to the top of this form and choose the option to request an appointment.

Please briefly explain why you are wanting to change your medication plan or dose. Long answers will not be processed; please try to keep the answer to 2-3 lines at most *

Blood Pressure & Heart Rate Monitoring

This section of the form asks you about your blood pressure and heart rate.

Please click on the button below to learn how to check your heart rate and blood pressure:

How to Check Your Heart Rate & Blood Pressure

Have you checked your blood pressure recently (for example at home, at the chemist or at your GP surgery)? *

YesNo

Please enter your blood pressure reading (for example 120/77) *If you do not have the exact reading available, please advise where your blood pressure was checked and what you were told about the reading - for example: "Checked at chemist 2 weeks ago - they said it was normal"

Please select one of the following preferences regarding blood pressure monitoring: *

I will check my blood pressure and will forward the readings to admin@drkatelaw.com.au - I am aware my prescription request may not be approved until this is completed I do not want to check my blood pressure. I am aware my prescription request may be declined as a result.

Please enter your current heart rate (in beats per minute). Instructions are provided below if you aren't sure how to check *

Is your heart beat regular or irregular? *

Regular - my heartbeats are evenly spacedIrregular - my heart beats are NOT evenly spaced apart OR they pause/skip unexpectedly

Irregular Pulse - What to Do

If you have an irregular pulse, and this has not been investigated before, please see your GP, as this could be a sign of a heart arrhythmia. Please note down any symptoms you experience when this occurs, such as lightheadedness, dizziness, sweating, shortness of breath, chest pain, palpitations, or fainting.

Emergency Care

In some cases, it is best to go to the emergency department or call 000, particularly if you are experiencing chest pain or severe shortness of breath, or if you have fainted or collapsed.

Pause Your Stimulant Medication

If you are taking stimulant medication, please stop taking it until your GP advises further. The cause of your irregular pulse will need to be determined before you resume taking your stimulant medication.

More Information

More information on heart arrhythmias is available on the HealthDirect website. Please click the button below to open this information in a new tab:

Arrhythmia Information

I confirm I will seek medical attention for my irregular pulse *

I will seek medical attention (either GP or emergency department)My irregular pulse is a pre-existing issue and there is a plan in place

Would you like to know about our Home BP Monitor Discount? *

YesNo

Please click on the button below for more information (opens in a new tab):

Home BP Discount Information

Prescription Fee Information

The standard prescription fee is $55 including GST.

The complex prescription fee is $99 including GST.

Complex prescriptions require additional time to complete to meet mandatory monitoring requirements and, if eligible, to complete the PBS authority application.

Please confirm you are aware there is a fee for prescription requests *

I am aware of the prescription fee and I would like to proceed with my prescription requestI do not wish to proceed

As you do not wish to proceed, please do not complete/submit this form. Please return to the top of this form and choose the option to request an appointment.

Prescriptions Required

Please enter the details of each prescription you would like to request. Please use a new section for each medication by clicking the box 'add another medication'.

Medication (name & strength): *

Current dose: *

When will your medication run out? *

Are you experiencing any side effects with your current medications? *

Yes - minorYes - majorNo

Please describe the side effects you are experiencing: *

Is your medication effectively managing your symptoms at the moment? *

Yes - I am happy with the effectNo - it is not effective, or not as effective as I had hoped. For now, I want to continue taking itNo - it is not effective, or not as effective as I had hoped. I want to change my medication plan as soon as possible

If your medication is not working well, please describe the reason for wanting to continue it (for now): *

When would you like your next appointment (approximately)? *

Other comments (optional):

Prescription Policy - Confirmation

ScriptCheck WA

Dr Law is required to check ScriptCheck WA for your medication dispensing history before prescribing any stimulants or other higher-risk 'monitored medications'. Please refer to this website for more information:

ScriptCheck WA Information

Please tick each box to confirm you are aware of the following: *

This request may take up to 7 days to be reviewed by Dr Law (longer wait times are expected during periods of leave)Approval is at Dr Law's discretion; submitting your request does not guarantee it will be approvedIf your request is approved, you will receive a script fee payment link via SMSThe prescription fee must be paid before your script request booking is scheduled in Dr Law's diaryDr Law will check your prescribing and dispensing history via ScriptCheck WA before issuing any prescriptions

Document Request

Document Fees

Document fees vary depending on the time and complexity involved. This service is not eligible for a Medicare rebate.

Please refer to the Fee Schedule for details:

Fee Schedule

Please confirm you are aware there is a fee for documents *

I am aware of the document fee and I would like to proceed I do not wish to proceed

As you do not wish to proceed, please do not complete/submit this form. Please email admin@drkatelaw.com.au to request an appointment with Dr Law if you would like your document to be completed during an appointment.

Would you like a quote of the estimated fee before going ahead? *

YesNo

Document Details

When do you need this document to be completed by? *We require a minimum of 7 business days' notice. Last-minute requests will not be actioned.

Please provide the details of the assignment you need an extension for *

Please describe the reason you require an extension. Be as specific as possible, including date of onset of symptoms, degree of impact on your functioning and what you have tried so far to manage this *

Your request is likely to be declined as this type of medical certificate usually requires an appointment.

If you wish to proceed with submitting your document request, please continue.

If you wish to proceed, please outline the exceptional circumstances that currently apply *

Please provide the unit name, semester of enrolment, and reasons for withdrawing *

What was the census date for the unit you are withdrawing from? Your university website will have this information available. If you leave this blank, the time taken for Dr Law to look this up will be reflected in the document fee charged

Was your condition known & causing an impact on your ability to complete the unit requirements before the census date? *

Who should the document be addressed to? *

Please describe the type of document you require *

Travelling with Prescribed Medications

Overseas Travel

You must research the legal requirements for bringing your medication into each country. Dr Law will not do this for you and will not accept responsibility for the consequences of your decision to take medications into a country that prohibits it.

Travel & ADHD Information

Please confirm you are aware of the following:

I am aware that I must research the law of each country I am visiting and transiting through before deciding to bring my medications with me. *

I am aware that I will need to check the Smart Traveller website to find out if my medication is legal in each country I am visiting. If I cannot find the answer online, I am aware I should contact the embassy of each country I am visiting. *

I am aware I may face serious legal consequences for bringing medications into a country that prohibits these medications. *

Which medications do you wish to bring with you? *

All of the medications Dr Law has prescribedSome of the medications Dr Law has prescribed - I will specify the details below

Please list the medications you will be bringing overseas *

Who would you like Dr Kate to refer you to? Please specify their name and role *

What is their practice name? *

What is the reason for the referral? Please keep your answer brief, as the time taken to read your response forms part of the document writing time *

Please give any information needed to complete your document (optional). Please keep your answers brief (dot points please - no long paragraphs). Lengthy answers will take time to read and the time required will be added to your report fee.

Document Policy - Confirmation

Document Request - Please tick each box to confirm you are aware of the following: *

This request may take up to 7 days to be reviewed and either approved or declined (longer wait times are expected during periods of leave)Once approved, requests are scheduled into Dr Law's diary and processed in the order they are received. Last-minute requests are not prioritisedLong or complex documents will require more time to schedule and complete. Dr Law will aim to provide an estimate of the turnaround time if my request is approved. You may need to pre-pay a portion of the document fee before work commences on long/complex documentsAfter your document is completed, you will be sent a payment link via SMS to pay your document fee invoiceYour document will be released following payment of your document fee

Please select the circumstances that apply to you: *

Preferred Name *

Middle Name *

Sex *

Gender Identity (Optional)

Preferred pronouns (optional)

She/her/hersHe/him/hisThey/them/theirs

Pronouns: comments (optional)

Occupation *

Relationship status

Contact Details

Patient - Mobile Phone *

Patient - Home Phone

Please note: appointment reminders will be sent via SMS and/or email. Other forms of correspondence may also be communicated via SMS and/or email.

Patient - Residential Address *

Patient - Postal AddressOnly complete if postal address is different to your residential address

Medicare Details

Medicare Number *

Individual Reference Number *

Expiry *

Who will be claiming the Medicare rebate? *

Patient Someone else

Please enter the claimant's details here:

The details of the claimant are required for the Medicare claim to be processed on your behalf. Once processed, the rebate will paid into the claimant's bank account by Medicare.

Name of Claimant *

Claimant Date of Birth *

Claimant Medicare Card Number *

Claimant Medicare Reference Number *

Emergency Contact Details

Please provide the details of your emergency contact. This person would not usually be contacted without your permission, unless it is an emergency.

Name *

Address *

Contact Number *

Email *

Consent

On very rare occasions, I am contacted by a person's family member, spouse, friend or other support person to discuss their condition or treatment. Although this doesn't happen very often, it is helpful to know what you would like me to do if someone contacts me.

The information we discuss can remain confidential unless you authorise information to be shared. There are some cirucmstances in which I cannot keep your information confidential, such as an emergency situation or if I reveuve a subpoena for your records.

If your next of kin, other family member or carer contacts Dr Law, do you consent to information being shared? *

YesNoI am unsure and would like to discuss this at my appointmentIt depends (please provide further information below)

Next of Kin More Information (Optional)

Healthcare Providers

Written Correspondence

Your referring general practitioner will receive a letter following your initial appointment outlining your history, symptoms, diagnosis and treatment plan. They will also receive regular updates regarding your condition and treatment. These letters are usually sent via secure messaging software. If your GP does not have this software, the letter will be sent by fax.

Correspondence will also be sent to your referring doctor regularly to ensure they remain informed of your treatment. You can also elect for your GP letters to be copied to your other healthcare providers below.

The following questions will ask for the details of your healthcare team. You do not need to include the referring doctor when answering these questions.

Is your usual GP different to your referring GP? *

YesNo

Please provide your usual GP’s details: *

Would you like regular updates to be sent to this GP? *

YesNoUnsure

Are you seeing a psychologist currently? *

YesNo

Please provide your psychologist’s details: *

Are you currently seeing any other healthcare providers not listed above, such as a medical specialist? *

YesNo

Please provide their name, role and practice details *

Additional Comments (optional):

Billing Information

Please confirm you are aware of the following information related to fees:

Consultations are not bulk billed & are not covered by private health insurance
Pre-payment of the estimated consultation fee must be received at least 2 business days prior to the consultation, via secure online payment or bank transfer
The total fee will be determined after the consult; extra time taken beyond the booked consultation duration will be charged as per the fee policy. Any additional fees will be invoiced following the consultation and are due the same day
Prescriptions, referrals, reports and other documents will not be released until payment is received
Admin fees apply for overdue fees as per the fee policy
Pre-payment may be required to book an appointment for those who have cancelled an appointment late or missed an appointment
If there is a need for treatments, such as medications, a procedure, and/or psychological treatments, there may be additional fees charged by the service provider. These fees are not set or charged by Dr Law and we recommend you enquire about costs with the service provider.
The fee policy and fee list can be accessed via the login protected area of Dr Law's website or upon request

Please review the fee policy and fee schedule documents (click button below to access):

Fee Policy

Fee Schedule effective 1st July 2023

Fee Schedule valid until 30th June 2024

I have read and understood the information about fees and billing *

Communication Policy

Please confirm you are aware of the following information related to fees:

Consultations are not bulk billed & are not covered by private health insurance
Pre-payment of the estimated consultation fee must be received at least 2 business days prior to the consultation, via secure online payment or bank transfer
The total fee will be determined after the consult; extra time taken beyond the booked consultation duration will be charged as per the fee policy. Any additional fees will be invoiced following the consultation and are due the same day
Prescriptions, referrals, reports and other documents will not be released until payment is received
Admin fees apply for overdue fees as per the fee policy
Pre-payment may be required to book an appointment for those who have cancelled an appointment late or missed an appointment
If there is a need for treatments, such as medications, a procedure, and/or psychological treatments, there may be

Our communication policy outlines how to contact us, which types of contact can be actioned, what to expect when communicating with us and our expectation that you will communicate respectfully with Dr Law and admin staff. The policy can be accessed here:

Communication Policy

I have read and understood the communication policy *

Upload Files

Click the button below to upload any files for Dr Law to review when processing your request (optional)

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