Repeat Prescription Request



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Your Personal Details

All prescription requests will be checked by a clinician before they are approved

How Would You Like To Send Your Request?
Please select one of these options to continue.
Medication Required

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

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.

Please tell us the name of the medication you require.
Please tell us the strength of the medication listed on your prescription slip
Please tell us how much you require. Please type a number in the box.
If you need more options please check this box
Photo of Prescription Request

If you have your repeat prescription request slip you can scan or photograph it and upload below:

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

Prescriptions will be sent electronically to the pharmacy of your choice as set in your health records unless stated otherwise.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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