Practice Survey Surgery Booklet (PDF Format) POLSKIE Version (WORD Format)
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Repeat Prescriptions

Prescriptions must be received in writing either via reception, in the post or by fax, or by filling out the request form below.

We are unable to accept repeat prescription requests over the phone as this causes confusion and mistakes can be made.

If you would like us to send your prescription to you please enclose a stamped addressed envelope.

Please allow two working days from when you drop in your request for your prescription to be ready for collection.

REPEAT PRESCRIPTION REQUEST FORM
* = Required field
First Names:
*
Last Name:
*
Date of Birth
(dd/mm/yyyy):
*
Email Address:
*
Phone Number:
 
Your Usual Doctor:
Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name
Strength
*
If you require more than 10 items, please submit another request.
Collection Point :
*
Comments:
(any comments that you may have about this service, or additional medication)

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above*

 

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