PLEASE NOTE THAT TO ENSURE A SAFE AND EFFECTIVE SERVICE IS PROVIDED TO ALL OUR PATIENTS, WE REQUIRE 48 HOURS NOTICE TO PROVIDE A REPEAT PRESCRIPTION.

The information you need to complete this online form can be found on the paper repeat prescription form issued with your last prescription. It is important that we receive a fully completed online form containing the correct information, otherwise we may be unable to issue your repeat medication.

We can only accept requests for items listed on your paper repeat prescription form and unauthorised items cannot be dispensed.

Repeat Prescription Form

* required fields

Patient Name:*

Address: *

Date of Birth: (dd/mm/yyyy) *

Home Telephone: *

Email Address: *

Description

Dose

Strength

Item 1: *

Item 2:

Item 3:

Item 4:

Item 5:

Item 6:

Item 7:

Item 8:

Item 9:

Additional Information:

If you require more than 9 items, please submit another request.