Request a Repeat Prescription

Using the form below you can request a repeat prescription from us if you are a registered patient of ours.

Please complete the form and once submitted you will receive an email confirmation of your request. No personal data is emailed along with this confirmation.

Title: (*)
Please make a selection from the list.
First Names (*)
Please enter your first name(s)
Last Name (*)
Please enter your last name
Please enter dates as numbers -
Date of Birth
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Home Address (*)
Please enter your house name or number and the street name
Town (*)
Please enter the town where you live
Post Code (*)
Please enter your post code
Contact Number:
Please enter a contact phone number.
Email (*)
Please enter your email address
Delivery Method (*)

Please select a delivery method
Prescription Items - please indicate medication, frequency and dose. (*)
Please indicate required prescription(s)
By ticking the box below, you agree to The McAndrew Practice Privacy Policy. You also agree that this data will be shared in line with the EU General Data Protection Regulation (GDPR). More details of both can be found on our Privacy Policy page HERE.
I agree to the Privacy Policy (link above) (*)
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