Request a Repeat Prescription Online

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. Please feel free to use our normal repeat prescription service.

NHS Number *
Date of Birth *

	Item Description (e.g. Paracetamol)	Dose (e.g. 500mg)	Quantity (e.g. 100)
Item 1 *
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10

Comments about this Prescription	Not for medical problems

* Required

Please allow 2 full working days for us to process your request. For those patients whom we dispense for, your items will be ready within 4 working days.

(We can only post your prescription to you if you provide us with a Stamped addressed envelope)