Repeat Prescription Request Form

Please ensure when ordering medication that you get the following message after submitting your request

"Your request has been successfully sent and the form cleared.
If you elected to retain your details, the form will be automatically populated the next time you visit."

PLEASE DO NOT CALL THE PRACTICE TO CHECK IF YOUR PRESCRIPTION HAS BEEN PROCESSED

All patients should have a nominated pharmacy who will collect their prescription from the practice on their behalf. 

Therefore there is no need to attend the practice as your medication will be available at the pharmacy.

Please allow 7 working days before collecting your medication from the pharmacy

NB - If you have run out of your medication and need it the same day you should not use this form.  Please contact the practice either in person or by telephone.

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Important Information

Saving details help

You do NOT have to register to order your repeat prescription - it is your choice.
If you do not wish to register simply use the form below to place your order.

There are some advantages to registering and you can read about them here. To register click the link above.

Choose a Patient

Patient Details

Medication

You may request up to twenty separate items. Enter each drug and strength on your prescription. Untick the 'Required' box if you do not require the item this time.
Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending
Drug Quantity and/or Strength
e.g. 1mg once a day 		Required
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Comments

Please do not include medical problems here - these should be discussed with your doctor

Sending Your Request





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About This Form

Fields marked with a red asterisk are
compulsory.

This form uses cookies to store your information for next time.

The information is stored on your computer when you send your request or when you switch patients - but only if you check the 'Remember my details...' box.

To save details for a second person use the radio buttons at the top of the form. To save details for more than two people or if you are having trouble with cookies, register with the prescription service and your details will be saved securely in the online database and recalled when you log in. Registering is quick, simple and free.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential. Where appropriate this data is deleted two months after its creation.

By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of ordering a repeat prescription.