COVID-19 Repeat Prescription Form

COVID-19 Repeat Prescription Form

Due to COVID-19(Coronavirus) we will be allowing patient to submit more forms online. This is so that we can reduce the number of patients that come down to the surgery. This is so we can reduce your risk of infecting and the risk to others.

Please let us know what pharmacy you would like your prescriptions to go to electronically as this will further reduce the need for you to come into the surgery.

Please allow 3 working days before collecting your prescription.

Please ensure you complete ALL of the sections marked with an * otherwise the form cannot be sent. You can request up to 6 items per form, if you have more than 6 items please complete further form(s).

Your Details

Please select which pharmacy to nominate for your prescriptions to go electronically?
E.g Atenolol
E.g 50mg NB:If required please type "percentage" not the symbol "%".
E.g 25 tabs