Prescription Request

Order a Prescription

Use the form below to request your repeat prescription online.

Please Note: You must be registered with our practice before submitting a request.

Important Information Before You Begin

Privacy and Security: To protect your personal data, this form does not store your details or medication requests
Confirmations: You will not receive an email confirmation. Once submitted, a success message will appear on your screen
Email Accuracy: Please double-check your email address before submitting. An incorrect email address will prevent us from processing your request.

Prescription processing: Allow 3 working days.

Cut-off time: Requests made after 2 pm, evenings, weekends, or public holidays will be processed on the next working day.

Pharmacy processing: Allow your pharmacy extra time to dispense medication after processing.

Ordering: Please order early, especially before weekends and public holidays.

Prescription Request

Repeat Prescription Request

First Name *

Last Name *

Email *

Enter 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

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Item 7

Item 8

Item 9

Item 10

Special Medication Request

Please Note: Special requests may not be authorised by the Doctor.

Collect form Collect form

If you select a pharmacy for collection, you must arrange and confirm this directly with them.

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.

If you are human, leave this field blank.