Bottles of pills
 
 
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SPRING 2008

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Please read this notice: This form is not sent via a secure server and is just like sending a normal email. 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. 
 
Patients Name*  
Date of Birth*    
Address    
Contact Tel.*    
Email Address    
Collection*    
Please allow 2 working days for collection from the surgery or 3 working days for collection from your choice of local pharmacy.  
   
* You must provide this information.

The items requested below MUST be on your regular
repeat medication list.
 		  
 

     Item Description

Dose

  Quantity
       (e.g. Paracetamol) (e.g. 500mg) (e.g. 100)
       
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
   
 		    

                          

 
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Information on this website is for registered patients only and should not be used as a substitute for seeking advice from a GP. 
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