Repeat Prescription

To request a repeat prescription, please enter your personal details below, followed by the name, strength and quantity of medication you require. Please allow at least 48 hours before visiting your collection point.

We can only process requests for repeat prescriptions – if you require a new medication you will need to book an appointment or speak to one of our doctors on the telephone.

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Your Details

Title

First Name Required

Surname Required

Date of Birth Required

Are you able to provide your NHS or Patient Number?

I have my NHS Number

I have my Patient Number

Not sure/ don't know

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Your Address

Address

Postcode

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Your Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

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Prescription Details

Preferred Collection Point Required

Comments

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Medication Required

Please state the Medication Name, Strength and Quantity required.

Medication 1 Required

Medication 2

Medication 3

Medication 4

Medication 5

Medication 6

Medication 7

Medication 8

Medication 9

Medication 10

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Repeat Prescription