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Prescription request – Practice Dr. med. Christin Lorenz

For existing patients on stable therapy. Every renewal is reviewed by the doctor for appropriateness beforehand; a prescription is not issued automatically.

You only pay once the prescription has been approved by the doctor. You will then receive a payment link for €29 by email. The first renewal after your Perimenopause Clarification is included.

Only I see your information. It is subject to medical confidentiality and processed in line with the GDPR. Details: drchristinlorenz.de/en/privacy.

Consent

I consent to my health data being processed to handle this prescription request (Art. 9(2)(a) GDPR). I can withdraw this consent at any time.

Medical review

I understand that every renewal is reviewed by the doctor for appropriateness beforehand and that a prescription is not guaranteed.

First name

Last name

Date of birth

Day

Month

Year

Email address

Mobile phone number

Which medications should be prescribed? Please use one line per medication: name, dose, since when.

When and by whom were the medications last prescribed?

What has changed since your last appointment?

When was your last gynaecological cancer screening?

Within the last 12 months

More than 12 months ago

I don't know

Postal address

Portuguese SNS number, Nº de Utente (only if you live in Portugal, if available)

You will receive your prescription by post in Germany, and electronically in Portugal, with the pharmacy codes by text message and email. Submitting does not mean automatic approval. The practice will get back to you by email. If a document is needed for the review, such as a photo of your last prescription, you will receive an encrypted upload link.