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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.

We aim to make your prescription available within 24 hours of your request. If you have requested that your prescription be sent to a local pharmacy, please allow at least another 24 hours.

 
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
   
* Not for medical problems *		    
Comments about this Prescription

 

                          

 
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Please note that any advice on our website is for registered patients only and it should not be used as a substitute for seeking advice from a GP.  Electronic transmission of data via our website (i.e. emails to us and using the electronic repeat prescription facility) may not be totally secure.
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