Prescription Requests

If you do not have a log in for Patient Access, you can use this form to submit your repeat prescription.

Prescriptions will usually be ready to collect in 5 working days. You can no longer pick up prescriptions on a Monday evening as from 18:30hrs  – 20:00 hrs we will only be open for pre – booked appointments.

First Name *

Surname *

Email Address *

Contact Phone Number *

Address

Date of Birth (dd/mm/yyyy) *

Town

Post Code *

Items:

Item 1

Strength

Item 2

Strength

Item 3

Strength

Item 4

Strength

Item 5

Strength

Item 6

Strength

Item 7

Strength

Item 8

Strength

Item 9

Strength

Item 10

Strength

Comments

PLEASE NOTE: Your prescription will go to the same place as your previous prescription, unless you specifically notify us otherwise. This now also applies to 'special requests'.