The Old School Surgery

This service is provided for patients convenience, the data provided by you is not secure or encrypted. Please only use this service if you have read and understood these conditions.

This online form is the ONLY accepted method for receiving online Repeat Presciptions.

All the information you need to complete this online form can be found on the paper Repeat Prescription form issued to you by your Doctor. It is important that we receive a fully completed online form containing the correct data in the order listed on the form otherwise a Repeat Prescription cannot be issued.

We can only accept Repeat Prescription requests for items listed on your paper Repeat Prescription form, unauthorised items cannot be dispensed.

If you would like this form to retain previously entered information you will need to ensure that your browser preferences are set to enable the use of cookies.


Repeat Prescription Form
 
Patient Name:
Address:
Date Of Birth:
Home Telephone:
Email Address:
       
  Item Description    
Item 1:
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Item 9:
Item 10:
Item 11:
Item 12:
 
Collect at surgery or named Chemist
(please specify)
   
Additional Information:
 
 

Please allow 2 full working days to collect your prescriptions or longer if you have designated a chemist to collect.

(If you send your on line request from a workplace computer, the firewall may not permit a confirmation email)