requestform

You can request repeat medication which your doctor has already set up for you on the surgery computer using the form below.

We cannot accept requests for any medication which is not on your repeat medication slip.
The prescriptions will be sent to the pharmacy which you have chosen in the past.
Prescription requests will usually be processed as soon as they are received, however, we ask you to allow 3 working days for processing and for them to be at the pharmacy to avoid disappointment.

You may find it easier if you have the slip from your last prescription to hand. Please list only the items you require this time. We ask you to state strengths to avoid confusion when two strengths of the same medication are used. Please include a telephone number at which you can be contacted during the day in case we need to contact you.

Please note that this form is sent over standard e-mail when transferring your message to the surgery. The data is not sent through a secure channel and could, possibly, be viewed by third parties.

Required fields are marked *

First Name*
Surname*
Date Of Birth (dd/mm/yyyy)*
Phone*
E-Mail
Postcode
Computer Number:
(Please include this 6 figure number shown on your repeat prescription slip if possible)

	Please list only the items you require this time with strengths.
Item 1:*
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Comment

Repeat Prescription Request Form