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.
Title
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First Name
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Surname
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Date of Birth
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Are you able to provide your NHS or Patient Number?
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Your Address
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Post Code
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E-mail Address
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Home Phone Number
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Mobile Phone Number
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Your GP
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Preferred Collection Point
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Comments
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Medication 1
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Medication 2
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Medication 3
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Medication 4
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Medication 5
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Medication 6
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Medication 7
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Medication 8
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Medication 9
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Medication 10
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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy. This information is not shared with any third party organisations. This information is retained for up to 28 days.