3 Proven Templates for Prescription Requests to Doctors

Below are three detailed templates tailored for different scenarios: general prescription request, refill request, and a request for a prescription based on a previous consultation or diagnosis.

1. General Request for Prescription





Subject: Request for Prescription – [Your Full Name]

Dear Dr. [Doctor’s Last Name],

I hope this message finds you well. My name is [Your Full Name], and I am writing to request your assistance with a prescription that I believe could significantly improve my health and well-being.


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Over the past few months, I have been experiencing [briefly describe symptoms or conditions], which have increasingly affected my daily activities and overall quality of life. After conducting some research and based on my past medical history, I feel that [Name of the Medication] might be a beneficial treatment option for me.

I understand that medication should be prescribed with caution, and I trust your professional judgment entirely. I am hoping you could assess whether [Name of the Medication] is suitable for my condition and, if appropriate, provide a prescription for it.

I am available for a consultation at your earliest convenience and can provide any further information or undergo any necessary evaluations you may deem necessary.

Thank you very much for your time and consideration. I look forward to your guidance and expertise on this matter.

Sincerely, [Your Full Name] [Your Contact Information]

2. Request for Prescription Refill

Subject: Request for Prescription Refill – [Your Full Name]

Dear Dr. [Doctor’s Last Name],

I hope you are doing well. I am reaching out to request a refill of my prescription for [Name of the Medication], which you previously prescribed to me for [briefly describe the condition or symptoms]. The medication has been instrumental in managing my condition and maintaining my quality of life.

Unfortunately, my current prescription is about to run out, and I would greatly appreciate it if you could authorize a refill for another [duration of the refill, e.g., 3 months]. My pharmacy information remains unchanged ([Pharmacy Name, Address, Phone Number]).

Please let me know if you require any further information from my end or if another consultation is necessary before issuing the refill.

Thank you very much for your continued support and care. Your guidance has been invaluable to my health management.

Best regards, [Your Full Name] [Your Contact Information]

3. Request for Prescription Based on Previous Consultation/Diagnosis

Subject: Prescription Request Following Consultation – [Your Full Name]

Dear Dr. [Doctor’s Last Name],

Thank you for the insightful consultation on [Date of Consultation]. I greatly appreciated your thorough evaluation of my symptoms and your recommendations for managing my condition, [Condition or Symptoms Discussed].

As discussed, I am writing to request a prescription for [Name of the Medication]. You mentioned this medication as a potential option to alleviate my symptoms and improve my condition during our conversation.

I am eager to start this treatment and hopeful about the positive impact it might have on my health, based on our discussion and your professional advice.

Could you please process the prescription at your earliest convenience? My preferred pharmacy is [Pharmacy Name, Address, Phone Number]. If there are any additional steps or information needed from my side, please do not hesitate to inform me.

Thank you once again for your attentive care and support. I am looking forward to beginning this new treatment under your guidance.

Warm regards, [Your Full Name] [Your Contact Information]


Each of these templates can be tailored further based on your specific situation, medical history, and relationship with the healthcare provider. 

It’s crucial to maintain a tone of respect and courtesy throughout the letter, acknowledging the doctor’s expertise and discretion in medical matters.

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