Repeat Prescription Order

Repeat Medication Order Form

* Indicates required field

Name *

First

Last

Address *

Date of Birth *

Phone Number *

Regular GP *

I would like to book a Flu Vaccine and confirm I am (select one from below) *

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

List Long Term Medications Required below [Medication name, strength and dosage] *

Please allow 48 hours for your Repeat Prescription to be prepared and sent to your choice of Pharmacy. Please note only long term medications can be requsted using this form. Please do nominate a pharmacy and we will notify them directly, if you do wish to collect your prescription, please telephone us before presenting. If you require none long term medication or have a medication query please contact the surgery on 049 8546222 (option 1) as we will be unable to repond to any query using this form. Our lines are extemely 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 stafety as well as the saftey of our staff. We appreciate your patience and undertanding. Please Click on "Submit" to forward your request. Many thanks.

Submit

​Repeat Medication Order Form

Repeat Medication Order Form