This facility is only for repeat prescriptions.

Please allow 48 hours for this service

Instead of the normal 24 hours for collection.



Your Name:*

Post Code*

Phone No:*

In case we need to contact you.



e-mail:


REMEMBER THE CODE

HAS TO BE IN CAPITALS



      

* required to send mail.



Your Doctor  

Who is your regular doctor

YOUR DATE OF BIRTH

   

Not esential but will help the staff


Repeat prescriptions

Message for surgery