Repeat Prescription Order

Repeat Medication Order Form

* Indicates required field

Name *

First

Last

Address *

Date of Birth *

If you are aged 65 years or over OR in an at risk group and wish to have the flu vaccine please book a vaccine on our website.

Phone Number *

Regular GP *

Select Your Preferred Pharmacy. We will arrange for your prescription to be passed to any of the Pharmacies listed below *

Please list Long Term Medications Required below [Medication name, strength and dosage is required] If medication is not listed in full we can not issue this prescription request. e.g. we are unable to issue requests such as "usual medications", "full prescription", "blood pressure tablets". Thank you for your understanding. *

Please allow 3 working days for your Repeat Prescription to be prepared and sent to your choice of Pharmacy. It is important to list your medication names, strength and dosages as omitting this information may result in us being unable to follow up on this request. Please note only long term medications can be requested using this form. Please do nominate a pharmacy and we will notify them directly. Please note we are unable to respond to other query using this form. Our lines are extremely busy at present but please do bear with us as we work through these changing times. . Please do not present to the surgery without speaking with us first, this is for your safety as well as the safety of our staff. We appreciate your patience and understanding. Please Click on "Submit" to forward your request. Many thanks.

Submit

​Repeat Medication Order Form

Repeat Medication Order Form