Repeat Prescription Request

MAY BANK HOLDAY MONDAY

To all our lovely patients. The practice will be closed on Monday 3rd May. Please make sure you, or your representative, have ordered your prescriptions in plenty of time to have enough medication for the long weekend.

Do you need to re-order your medication? You can order repeat prescriptions online.

Due to increased Covid 19 demands on the surgery and the local pharmacies the method or ordering repeat prescriptions will be changing.

All new and existing patients will need to complete a repeat prescription ordering form for the new service. All patients must have a valid email address for this new service and is used solely by you or your representative.

Please keep watching the website for more information.

You must be a registered patient with the practice before we can accept your request.

For further information please refer to our repeat prescriptions policy.

PLEASE NOTE THAT THIS FORM IS FOR ORDERING REPEAT MEDICATION ONLY. DO NOT USE THIS FACILITY FOR REQUESTING MEDICAL ADVICE.

First name*

Last name*

Email*

Date of Birth*

day/month/year

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

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.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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

Repeat Prescription Request

Prescription Items

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