Repeat Prescription

It’s quick and simple to order your repeat prescriptions online. You must be registered with the Practice before we can accept your request.

Your prescription will be ready for collection after two full working days.

Repeat Prescription Request

First Name *

Last Name *

Email *

Enter Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

May we contact you by text message in relation to your appointments or healthcare? *

Yes

Your phone number for text messages (this must be a UK number) *

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice. e.g. Loratadine 10 mg

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Special Medication Request

Please Note: Special requests may not be authorised by the Doctor.

How would you like to collect your prescription?

Collection from Reception

Collect from your preferred Pharmacy

Collect from *

Privacy Policy

Please read our Privacy Policy.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.

I consent to the practice collecting and storing my data from this form.

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