Repeat prescription request

Section

Confirmation

I have no objections to my email address being added to my medical record as a future form of correspondence. Please note, this will only be used for actions such as sending letters to you or reminding you of reviews and will not be used for any marketing purposes.

Which surgery is normally attended? *

Mile End Surgery

Tuckswood Surgery

Gurney Surgery

Medication Required

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Additional Comments

Collecting your prescription

I have nominated a pharmacy and will arrange my collection from the pharmacy.

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Section

Medication Required