Repeat Prescription

Repeat Prescriptions

	Please remember to have your eye tested by the optician once a year if you have Diabetes.

	You can submit your change of details online.

	If you are on Lithium, you need to have your Lithium level checked every 6 months.

	If you have Diabetes, your blood pressure should be 140/80 or below. If not speak to your doctor about this.

To avoid any errors, telephone requests for repeat prescriptions will not be accepted.

You may write in or fax your request or hand it in at the reception.
You may use the printed list of your medication that came with your last repeat prescription for this request.

Please allow 2 FULL WORKING DAYS for your prescription to be ready for collection.

If you would like us to post your prescription to you, please enclose a stamped addressed envelope and allow plenty of extra time for the prescription to arrive.
We are not responsible for any losses or damages that may result from any postal delay by the Royal Mail.

You can also arrange with a local chemist of your choice to collect the prescription for you.

Please note that there is a date for your next medication review printed at the bottom of the repeat request. Please make an appointment for a medication review if this date is near or overdue. You may be asked to make an appointment if you have not done so.

Alternatively, you may wish to use the secure form below to send your repeat prescription request online.

Please remember the review date rule also applies for online repeat.

This form is sent to us in an encrypted format and it is secure.
It ensures secure data transfer between your computer and our secure server.

Please fill in the details in the boxes provided.
Please enter any comments about your medication or any other matters in the comments box.

Please provide your email address in the email box if you wish us to contact you in case of any queries.

Please remember that all your health information including your email address remains confidential and secure and we will always ensure that we have your written consent prior to releasing any information about you to parties outside the NHS.

When done please click the submit button ONCE.

If you require more than 9 items, you may send in 2 separate page submissions.

All items marked with a star (*) are required fields.

	First name*
	Last name*
	Date of Birth* (dd/mm/yyyy)
	Address*
	Post code*
	Telephone*
	Your Doctor*
	Your email*
	Comments
	Where to collect*

	Drug name	Strength and Type (e.g.. 500mg, 100mcg and Tablets / Caps / Drops / Liquid / Spray...)	Dosage (1 tablet daily, 1 puff twice daily...)
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		Press Submit ONCE only

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