Corkland Road Medical Practice

HOW DO I....
Obtain A Repeat Prescription?

Repeat prescriptions are issued at the doctor’s discretion and are usually for patients on long-term treatment. Requests can be made by fax, by post (enclosing a stamped addressed envelope), or in person. Please allow 48 hours’ notice.

THIS FORM BELOW IS CURRENTLY DISABLED - PLEASE USE ONE OF THE ALTERNATIVE METHODS MENTIONED ABOVE TO REQUEST PRESCRIPTIONS.

REPEAT PRESCRIPTION REQUEST FORM
* = Required field
First Names:
*
Last Name:
*
Date of Birth
(dd/mm/yyyy):
*
Email Address:
*
Phone Number:
 
Your Usual Doctor:
Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name
Strength
*
If you require more than 10 items, please submit another request.
Collection Point :
*
Comments:
(any comments that you may have about this service, or additional medication)

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above*

spacer
Advetise Here - Special rates for local businesses
spacer
pay monthly websites
spacer

spacer
spacer