You may be able to obtain a repeat prescription without seeing your doctor. When your doctor has agreed, you can order your repeat prescription by completing this form which will then be sent to us by email. Please be aware however, that 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.

Surname:
Forename:
Date of Birth
Email address
Phone Number Home
  Mobile
  Work
Usual GP  
Usual surgery  
     

Drug Name

Strength

Quantity

Comments

     
Please allow 2 working days for your prescription to be processed and collect after 3:30pm. Thank you.