Repeat Prescriptions

You can now order repeat prescriptions online. Please fill out the form below and click the Send Prescription Request button. All the information you need to complete for this form can be found on your repeat prescription as issued to you by this surgery: your patient number will usually be found near the top right, the drug strength will be found just to the right of the drug name.

Please complete all fields marked with an asterisk* (you MUST fill in at least one of the date of birth, patient number and NHS number fields). Use the Comments/Other Information box to tell us about any other details that may be relevant to your prescription.

First Name*

Last Name*

Date of Birth (DD-MM-YYYY)		Patient Number		NHS Number
*--

Daytime Phone Number

Email Address

Drug Name	Strength	Comments/Other Information









Prescription to be collected from: