Repeat Prescriptions

Patients on regular medication will be given repeat prescriptions on a computerized slip, part of which is kept by the patient for requesting further medication.

Please tick the items you require on the request slip and return by post or hand to the surgery.
If you have more than one repeat prescription, please try and order all your items together.
Clearly indicate where you would like the prescription form sent on the repeat prescription request form.The options are:-
- Collection from the Practice by yourself
- A pharmacy of your choice to collect it from the Practice and dispense it on your behalf.

For medico-legal reasons we cannot take prescription requests over the telephone as errors can occur in verbal communications.

Please state clearly which medicines you require.
You may find it helpful to use your computerised slip to help you remember names of medicines.
We may need to contact you to confirm your request
Repeat prescriptions are not usually given for the Contraceptive Pill or HRT Treatment and will be given only after seeing the Doctor or Practice Nurse.
Please allow 2 working days (48 hours) for your prescription to be processed.

Repeat Prescription Request.

(* = required field)
First Name*
Last Name *
Date of Birth *
Email *
Contact Number *
This number is for
Your usual Doctor
Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip
Drug Name 1*
Strength Drug 1 *
Drug Name 2
Strength Drug 2
Drug Name 3
Strength Drug 3
Drug Name 4
Strength Drug 4
Drug Name 5
Strength Drug 5
Drug Name 6
Strength Drug 6
Drug Name 7
Strength Drug 7
Drug Name 8
Strength Drug 8
Drug Name 9
Strength Drug 9
Drug Name 10
Strength Drug 10
I would like to collect my prescription from:
Extra information Please add any extra information here
Terms (You must read and tick the box before you submit)
I understand that only my usual and regular prescriptions can be requested by email or online form
I understand the practice may need to contact me by the telephone number provided
I understand that the practice cannot be held responsible for any technical problems that may occur that result in the practice not receiving this request and thus the repeat not being issued
I agree to the above terms and conditions of use (tick box)

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