Repeat Prescriptions Request Form

Please fill in the following form to request repeat medication. If you need to order acute medications, please contact the surgery.

Please:

  • Ensure that you have included your full name and address and a contact telephone number.
  • Be precise with medication
  • Detail exactly the strengths
  • Indicate if you intend to collect your prescriptions from the surgery (indicate which site) or a chemist.
  • Allow 2 working days for your prescription to be processed
  • In future you may wish to consider using Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.
Title
Date of Birth
Address
Email Address

Enter each medication and strength on your prescription

Medication
Medication
Strength
Dose