Repeat Prescription Request Form

Please use the below form to order your repeat prescription. Once you have submitted your request you will receive an email confirmation that your request has been successfully submitted. Please allow 48 hours, excluding weekends and Bank Holidays, for your request to be processed. Any problems please telephone the surgery. Please note we will email you if we cannot issue your request. If you are requesting an item urgently please contact the surgery and we will be happy to confirm if it is ready for collection.

Sometimes we may not be able to issue certain medications on a repeat prescription request.

Please note the Repeat Prescription Request form does not remember your previous prescription requests. Due to feedback gained from our website service provider from surgeries and patients across the country this service has been designed to be convenient to the majority of patients using the system. For this reason this service no longer requires patients to login to request a repeat prescription. Due to the security reasons associated with patients not being logged in when ordering a repeat prescription we have been advised that it is best practice that the system should not remember your previous prescription requests.

We apologise for any inconvenience this has caused to some of our patients. We are taking steps to improve this service and are considering a number of options. We will keep you informed on the progress.

About You

Please include all your given names.
Please use this date format: DD/MM/YYYY.

Medication Required

You may request up to ten separate items. Enter each drug and strength on your prescription.

Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending

Item Description
Strength
Quantity

Additional Medication Required

Item Description
Strength
Quantity
Please do not include medical problems here - these should be discussed with your doctor.