Order Your Repeat Prescription Online

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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. If you haven't registered for your PIN yet then please click here to find out what to do
Patients Name *
Date of Birth *
Address
Contact Tel.*
4 digit PIN *
Your Doctor
Please send my prescription to:
* You must provide this information. The items requested below MUST be on your regular repeat medication list - if you require any other medication please arrange a telephone consultation to discuss this with a doctor.
	Item Description	Quantity
	(e.g. Paracetamol)	(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

Please allow 2 full working days for us to process your request.
You must allow an extra day if you want your prescription to be
forwarded direct to the Chemist ready for collection.
(We can only post your prescription to you if you provide us with a
Stamped addressed envelope)