Repeat Prescription Request Form

REPEAT PRESCRIPTIONS

The majority of repeat prescriptions are issued via our computer and require 4 working days to process. When you require a repeat prescription please complete the tear off slip on the previous prescription and return it to the surgery. If this is not available please write all your details clearly on a sheet of paper (name, date of birth, name of item, strength, dosage and the local chemist of your choice). The 2 pharmacies in Peel and 1 in Kirk Michael operate a system whereby they collect prescriptions from the surgery and the patient can then collect their items later in the day directly from the pharmacy.

Urgent /Late requested medication – Urgent/Late requests put unnecessary pressure on the doctors and staff at the surgery. The doctor will always review a late / urgent requests for medication, but if they feel that the medication is not required urgently you may have to wait the required time for your prescription.

Urgent/late request, please note that the doctor may feel that the medication is not required urgently and that you have to wait the required time , urgent / late prescriptions need to be collected from the surgery. We will text or contact you once it has been done. Please note if you do note hear from us this means that the gp feels it is not urgent and your prescription will be done in 4 working days.

Please request your medication in plenty of time, put a note on your calendar the week before or set an alarm on your mobile telephone. Thank you.

You can order online from our website

www.peeldoctors-iom.com or

by signing up for Patient Access where you can book appointments and order repeat prescriptions on line

We regret that we are unable to accept requests for prescriptions over the telephone. This is to avoid mistakes and to guard against the telephone lines from becoming too busy and preventing any emergency telephone calls from getting through.

Full Name:
Date of Birth:
Email:
Confirm Email:
Daytime Tel:
Your Doctor:
Collect From:

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 Toggle all required
1.	Drug	Quantity	Item required or not
2.	Drug	Quantity	Item required or not
3.	Drug	Quantity	Item required or not
4.	Drug	Quantity	Item required or not
5.	Drug	Quantity	Item required or not
6.	Drug	Quantity	Item required or not
7.	Drug	Quantity	Item required or not
8.	Drug	Quantity	Item required or not
9.	Drug	Quantity	Item required or not
10.	Drug	Quantity	Item required or not
11.	Drug	Quantity	Item required or not
12.	Drug	Quantity	Item required or not
13.	Drug	Quantity	Item required or not
14.	Drug	Quantity	Item required or not
15.	Drug	Quantity	Item required or not
16.	Drug	Quantity	Item required or not
17.	Drug	Quantity	Item required or not
18.	Drug	Quantity	Item required or not
19.	Drug	Quantity	Item required or not
20.	Drug	Quantity	Item required or not

Repeat Prescription Request Form

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