Repeat Prescriptions

HOW DO I....
Obtain A Repeat Prescription?

Please order repeat prescriptions at least 48 hours in advance.
Requests may be made:
• In writing and left in a box in the waiting room.
• By post, enclosing a stamped addressed envelope.
• By fax on 01422 322645.
• By email to prescriptions@gp-B84012.nhs.uk

THIS FORM BELOW IS CURRENTLY DISABLED - PLEASE USE ONE OF THE ALTERNATIVE METHODS MENTIONED ABOVE TO REQUEST PRESCRIPTIONS.

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*

HOW DO I.... Obtain A Repeat Prescription?

HOW DO I....
Obtain A Repeat Prescription?