Repeat Prescription Order Form

We recommend all patients register to order prescriptions using Patient Access or the NHS App, but if you are unable to use these services, or need to submit a repeat prescription request for a child under the age of 16, please complete this form.

Please allow three working days for us to process your request. Your prescription will be sent direct to your nominated pharmacy for collection, or where there is no nominated pharmacy, to be collected from the surgery. If your prescription is processed over the weekend. Please note it will not be ready for collection until after 3 working days

Emergency prescription:

We do not do on the day emergency prescriptions. Did you know you can request emergency prescription without contacting your GP surgery? You can request emergency supply of your repeat medication by visiting https://111.nhs.uk/guided-entry/medicines-help

Personal Details

Name: *

Date of Birth: *

Address: *

Daytime Tel: *

Name/s of repeat medication you would like to order: *

or Cancel