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Online Prescriptions 
   
  First Name *   * You must provide this information.  
  Surname *    
  Date of Birth *    
  Contact Telephone *  

 

 
  Address *    
  Select Your Usual Doctor *      
               
  Item   Strength   Chemist    
  e.g. Paracetamol   e.g. 500mg        
   

   
         
         
         
         
         
         
         
         
         
               
  Comments      

                                 

 

Online Prescription Security
PLEASE NOTE this is NOT a secure form.
This form is sent to us via computers that do not belong to the NHS in a non-encrypted format. Complete confidentiality for this type of repeat prescription request can not be guaranteed. If you have an issue with this please feel free to use our normal repeat prescription service.