Repeat prescriptions form

Please use the form on this page to request repeat prescriptions.

"*" indicates required fields

Please select the Practice you wish to collect your medication from*

Name*

First Last

Date of birth*

NHS number

Email address*

Enter Email Confirm Email

Address*

House name or number Address Line 2 Town or city County Post code

Daytime telephone number*

Mobile telephone number

Please use the (+) button at the end of the row to add as many rows as you need for your medications.

List*

Item 1 - eg Atenolol

Strength 1 - eg 50mg

Quantity 1 - eg 28 tabs

Do you need to tell us anything else?

Date published: 8th October, 2025
Date last updated: 10th August, 2026