Repeat Prescription Request Form

* Please note this online service will be closing soon as it has been replaced by patient access for online appointments and prescription requests *

If you have not got your login details please visit reception with a form of photo ID.

New patient access site is :-

This service is in the process of being replaced by our NEW patient access system as detailed above which is more up to date and also allows you to book online appointments. If you are not registered for Patient Access please call in to reception with some ID so that we can issue you with passwords.

If you are on Blood Pressure medication, please have a check between 1st July and 31st March each year.  Please contact the surgery to arrange this.

Online appointment system now available call in to reception with ID for your login details.

Please Note the Patient ID is compulsory.

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


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


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

Sending Your Request

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Take our patient survey

About This Form

Fields marked with a red asterisk are

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.