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Prescription Form

Before using this form please read the notes HERE. Please make sure you complete the form accurately. Fields marked * are compulsory. Click the Order Repeat Prescription button at the bottom of the form when you have completed it.

Patient Number:*
Date of Birth:*
Repeat Prescription Items:
  Description Quantity

*1:

2:

3:

4:

5:

6:

7:

8:

Any message

Email address:*
If you are happy for us to contact you by email, tick here:

I have read the Repeat Prescription notes* (type YES):   

Please allow three working days (excluding Saturday) before collecting your medication from the dispensary. Please note that requests sent after 5pm will not be processed until the following morning.

If you collect your medications from a pharmacy, please be aware that the 72 hour service does not apply. Please telephone the surgery to check the current prescription collection arrangements for your pharmacy.

When the Practice is closed, you should use the NHS 111 service if you urgently need medical help or advice but it's not a life-threatening situation. Calls are free from landlines and mobile phones.

For immediate, life-threatening emergencies, continue to call 999.