IT’S MOVEMBER – MEN ….GET YOURSELF CHECKED OUT!

Just call the surgery on 01592 780277 ( you don’t have to ‘phone at 8am ) and ask for a ‘prostate check’ and our team will do the rest. A

Repeat Prescription Request

Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. Please allow at least 48 hours or longer before collecting your prescription from your chosen Pharmacy.

Please Note: THE SURGERY WILL BE CLOSED ON:

WEDNESDAY 25th DECEMBER 2024

THURSDAY 26th DECEMBER 2024

WEDNESDAY 1st JANUARY 2025

THURSDAY 2nd JANUARY 2025

Please ensure you do not run out of medication and allow the Practice additional time to process prescriptions.

Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission. It is important to enter your correct email address failure to do so will result in non-delivery of your request.

Repeat Prescription Request

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Your phone number (this must be a UK number) *

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice. e.g. Loratadine 10 mg

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Special Medication Request

Please Note: Please only include the additional medication details here. Please do not use this space for other correspondence. Special requests may not be authorised by the Doctor. Thank you.

Name and address of Pharmacy for collection *

Please arrange this with your pharmacy

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.

I consent to the practice collecting and storing my data from this form.

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IT’S MOVEMBER – MEN ….GET YOURSELF CHECKED OUT!

Repeat Prescription Request

Prescription Items

Privacy Policy

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