Online Prescriptions

Online Prescriptions

Prescriptions will generally be available for collection after a minimum of 24 hours
Requests received after 12 pm will generally be available for collection after a minimum of 48 hours
Please be aware that weekends and Bank holidays will affect these times

Please Note: This form is sent to us via computers that do not belong to the NHS in a non-encrypted format. Complete confidentiality for this type of repeat prescription request can not be guaranteed. If you have an issue with this please feel free to use our normal repeat prescription service.
Patients Name *
Date of Birth *
Address
Contact Tel.*
Email Address
Collection
* You must provide this information. The items requested below MUST be on your regular repeat medication list.
	Item Description	Dose	Quantity
	(e.g. Paracetamol)	(e.g. 500mg)	(e.g. 100)

Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8

To reduce spam please enter the red six letter word in lowercase into this box.*
	* Not for medical problems *
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