Online Prescription service

Use the simple form below to request medication. You must be a permanently registered patient to use this service. Patients must collect their Prescription from their chosen Pharmacy.

Please allow 72 hours or 3 working days for all repeat prescription requests. Allow 4 working days if your prescription is collected from a Pharmacy. IT IS YOUR RESPONSIBILITY TO ENSURE THAT YOU HAVE ORDERED YOUR MEDICATION IN PLENTY OF TIME

PRESCRIPTION ORDERING

There are various ways that you can order a prescription with us, please see the list below:

You can hand in your Repeat Request slip to your usual pharmacy
You can have your Local Pharmacy request on your behalf
You can complete the Request Form at our reception desk
Or you can complete the form below

Repeat Prescription Request

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

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Special Medication Request

Please Note: Special requests may not be authorised by the Doctor.

Pharmacy for collection Pharmacy for collection

Please arrange uplift with your preferred Pharmacy

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

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