Repeat Prescription Request Form
You can register for Vision Online Services and order your repeats from your own records. You will also be able to make/cancel appointments using this service. Please complete the form below and hand in to reception with photo ID and they will give you the information to enable you to create a username and password.
PRESCRIPTION COLLECTION TIMES:- BETWEEN 11-12 NOON AND 4-5.30 PM ONLY.
Online Services Registration Form
You can order your repeat prescription using any of the following options:-
Phone the surgery at any time (24 hour prescription line) and select option 1 to leave your repeat prescription request.
In person or by post. There is a mail box in the foyer.
Order online. It’s easy to register - pick up an information pack at the surgery. This new online service is connected to your medical record and will list your repeat medication.
IN A BID TO HELP THE ENVIRONMENT, REPEAT MEDICATION SLIPS WILL NOT BE PRINTED OFF AUTOMATICALLY. THIS WILL ONLY HAPPEN WHEN MEDICATION CHANGES OR IF YOU SPECIFICALLY NEED ONE.
Important Information
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
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Medication
Comments
Sending Your Request
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.