REPEAT PRESCRIPTIONS

By using the form 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

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Telephone

Country

(###)

###

####

Delivery Method

Independent dispensary

Post

Collect

Prescription Items - please indicate medication, frequency and dose

Please remember to allow 24 working hours for us to process your request. Most prescription requests are usually processed the same day. Thank you.

I agree to the Privacy Policy

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.

Agree

REPEAT PRESCRIPTIONS

Address

Practice Hours

Contact