Prescription request

Please complete the online form below for any prescription requests.

Name(Required)

First Last

Date of birth(Required)

Email(Required)

Enter Email Confirm Email

Daytime telephone number(Required)

So that we can contact you with any queries

You can add up to 12 items on this form. As you type in each item another set of boxes will appear.

Item 1 - eg Atenolol(Required)

Strength 1 - eg 50mg

Item 2

Strength 2

Item 3

Strength 3

Item 4

Strength 4

Item 5

Strength 5

Item 6

Strength 6

Item 7

Strength 7

Item 8

Strength 8

Item 9

Strength 9

Item 10

Strength 10

Item 11

Strength 11

Item 12

Strength 12

Additional information

Terms & Conditions

You can request a repeat prescription by completing and submitting an online form. By completing this form you agree to read and accept our terms and conditions

The service is provided only to request prescriptions. It is not to be used to request advice or assistance on any other matter.
If the date for your next review with a doctor or nurse has passed you may be asked to make an appointment.
Your prescription will be processed at the Practice within 48 hours (excluding weekends and public holidays). Please note: Special Requests (items not put on your list by the GP) may take longer at up to 72 hours. If you have requested this to then go to a pharmacy, their dispensing times are not included in these 48/72 hours and may take longer.
Absolute confidentiality is not possible because we cannot guarantee the security of the Internet. If you are not comfortable with this arrangement you may prefer to order your prescription in person or by post.
The practice cannot be held responsible for any delay in receiving your request, nor any technical failure of the system. Please make sure you order repeat prescriptions in plenty of time.

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help

Terms & Conditions

Helpful links

Further Info