PRESCRIPTION REQUEST

Use this form to order repeat prescriptions online. Please find your computer number on the top-right of your repeat prescription form. This is your unique number on our computer system.

We can only issue items shown on your repeat prescription form. Please enter them on the form below as they appear.

Please bear in mind that this form will be sent on e-mail.

Pressing ENTER will submit the form. To move to the next field please use the TAB key.

Please do not order repeat prescriptions of the contraceptive Pill using this form. We have a weekly drop-in pill clinic at 8:30am every Thursday.

Prescription Details

Computer Number:
Name or Birthdate (for confirmation):
Please List Medicines Required:

APOLOGIES IF THIS FORM IS NOT WORKING ON YOUR SYSTEM, WE ARE PUTTING IT RIGHT SHORTLY.