Repeat Prescription Form

Please note that this Repeat Prescription Request form is only available for patients under the age of 16.

 

Aged 16 or over? We are no longer accepting requests via the current online form for patients aged 16 years and over. If you are 16 years or over you can now request your repeat prescription either via the new online service "Patient Access", click HERE for more information, or alternatively you can use the right-hand side of your last prescription by ticking the items you need and dropping the request into the surgery.

Please note that repeat prescriptions cannot be processed over the phone or by email.

Alternatively you can use the right-hand side of your last prescription by ticking the items you need and dropping the request into the surgery. Please note that repeat prescriptions cannot be processed over the phone or by email.

 

Please allow 3 working days before collecting your prescription.

Please ensure you complete ALL of the sections marked with an * otherwise the form cannot be sent. You can request up to 6 items per form, if you have more than 6 items please complete further form(s).

Please note that we are moving to a new online service called "Patient Access" where you can book/cancel appointments, see what medication you have been issued and allows you to request repeat prescriptions. You will need to register for this online service. For more information please click here.

 
Your Details

Click here if you don't know your patient number

Click here to see how your printed prescription relates to the form

Item eg AtenololStrength eg 50mg NB:If required please type "percentage" not the symbol "%". Amount eg 28 tabs

Mandatory: To help us distinguish between forms submitted by individuals and those automatically generated by spam software, please type the word shown here into the box below.