Cheylesmore Surgery

How Do I....
Obtain A Repeat Prescription?

Most repeat prescriptions are printed by the computer. To order your next prescription please return the counterfoil marking the items you require. All requests will take 48 hours to process. We would appreciate it if you would collect your prescription after 10.00am when we are less busy. If you would like it posted, please enclose an SAE. We will take requests over the phone for the housebound only.

THIS FORM BELOW IS CURRENTLY DISABLED - PLEASE USE ONE OF THE ALTERNATIVE METHODS MENTIONED ABOVE TO REQUEST PRESCRIPTIONS.

REPEAT PRESCRIPTION REQUEST FORM
* = Required field
First Names:
*
Last Name:
*
Date of Birth
(dd/mm/yyyy):
*
Email Address:
*
Phone Number:
 
Your Usual Doctor:
Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name
Strength
*
If you require more than 10 items, please submit another request.
Collection Point :
*
Comments:
(any comments that you may have about this service, or additional medication)

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above*

spacer
Your Business Here
spacer
pay monthly websites