We can only issue a repeat prescription if the following conditions are met:

  1. You fill in all the fields marked *
  2. Your doctor has already authorised you to have a repeat prescription
  3. You still have valid issues remaining (e.g. if you have been authorised for 4 repeats, and you have taken only 2 repeats so far)

If these criteria are not met, please do not submit an online repeat request as we will simply ignore it.

Please note that the information on this form will be submitted by unencrypted e-mail. This is currently a limitation with the NHS net. Do not press RETURN until you reach the end of the page because this will submit your form. Use the TAB key to move down to the next field.

Personal Details *Return email address: *Last name: *First name(s): Title: Mr Mrs Miss Ms Other: *Date of Birth: *Address: *Usual doctor: Please list the medicines you wish to obtain on repeat prescription: Medicine: Dose: *I have read the criteria for submitting an online repeat request. This request fulfils the criteria *I understand that this data will be submitted as an unencrypted e-mail