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South Ham Repeat Prescriptions

Please put your name EXACTLY as it appears on your repeat form.

First Name: (required)

Last Name: (required)

Date of Birth (dd.mm.yy): (required)

Patient Number: (the number at the top of your repeat form e.g. 20002)

Contact Telephone No.: (a number we can contact you in case of queries)

Please note, medications can only be ordered using this online system if there are authorised, in date repeats on your last repeat form.

Please indicate the medications required exactly as they appear on your repeat form:

Repeat Prescription Item 1: Quantity:
                                                 (e.g. Atenolol Tablets 25mg)                (e.g. 28)
Repeat Prescription Item 2: Quantity:

Repeat Prescription Item 3: Quantity:

Repeat Prescription Item 4: Quantity:

Repeat Prescription Item 5: Quantity:  

Repeat Prescription Item 6: Quantity:

If you require more than 6 items at any one time, please complete and submit a first form and then put the remaining items on a second form.

Please indicate where you would like to collect your repeat prescription, by choosing an option from the dropdown list in the following box:  

Please allow 2 working days before collecting your prescription from the surgery. When we have received your email request for your repeat prescription, we will send a reply to confirm this.