Repeat Prescription request

= Essential Information

Please allow 48 hours before you collect your prescriptions, and remember we are closed on Saturdays.

*Name:                                      *Date of Birth..

*Daytime Tel. No:            Email Address:    

The following information as seen on your repeat prescription slip HELP

          *Name of Drug                                            *Dosage/Quantity                           *Strength                                                                  

                              

                              

                              

                              

                              

                              

   If you need to order more than six items please submit a second form.  

   (Please check required button)

*Collect from Dispensary          **Deliver        Chemist        

 *Selecting 'dispensary' if you are not a dispensing patient means that you intend to collect the printed prescription from the dispensary

Opening Hours: 9am - 1pm and 2.15pm to 6pm Monday to Friday

** Please Note:   The delivery service is only for those patients over 60 years who find it difficult to get to the surgery

Any Additional Information:                                          

 Any information you enter here is only used for prescription renewals and every effort is made to ensure the privacy of your request.  

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