Repeat Prescription Request Form

Please complete the online form below to request a repeat prescription.

Date of Birth
Email Address

Enter each medication and strength on your prescription

You may request up to twenty separate items. Enter each drug and strength you need to order. Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending
Please do not include medical problems here – these should be discussed with your doctor
Remember me?
Remember my details – We’ll save a copy of your details on your computer and pre-fill them automatically when you next visit this page. Do not select this option if you are using a shared device.