Repeat Prescription Request Form

On line Prescription Ordering has changed.  You can no longer order your repeat prescriptions in the old way.  You need to register for Patient Access, this will enable you to order prescriptions and book appointments on line.

To register for this service please contact the surgery to collect a registration letter.

PLEASE DO NOT ORDER YOUR REPEATS ON THE UNDER 16 YEAR OLDS UNLESS YOU ARE UNDER 16.

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

This form can remember details for up to two people - you must register to store more

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.