Repeat

PRESCRIPTION ORDER

FORM


BOOKMARK THIS PAGE

GO DIRECTLY TO ORDER FORM -- (For those familiar with using the form - otherwise please read the following introduction).

There is an AUDIO version of the instructions.

Please MAXIMISE this window for CLARITY.

We now offer the facility to our patients to order their routine repeat prescriptions by email. The following conditions must be satisfied though:

We have provided on the form sufficient space for you to order four items. If you need more then send more than one form please.

If you have a query about a drug or wish something different or if your repeats have expired you should contact the surgery in the normal way. There is a facility at the Virtual Surgery to ask questions about your medication but you must allow a week to receive a reply.


If you wish all your items to be issued enter in the FIRST ITEM field "all" followed by the total number of items in brackets - to serve as a check. e.g. "all(6)". However, if the number does not tally with what we have on record we will have to email you back causing delay.


Information on medications is available at Virtual Health Network who also provide authoritative information to the profession. Please go there if you are uncertain about the details of your medication or want to find out more about it. (Opens in a NEW WINDOW so that you can peruse it whilst filling in your order form)


First please tell us your email address - we cannot process the form without it.

Now give us your name AND/OR your identification number (found to the left of your name on the green counterfoil).


FIRST ITEM - enter the name of your first item (or "all" followed by number in brackets [see above]). Long names may be abbreviated but give us enough information to definitely identify it.
Now dose - optional unless you have the same medication in two or more doses
Now the form = e.g. tablet, capsule, ointment, cream, gel etc. - only required if more than one form is authorised for you for the same medication.


SECOND ITEM - As for the first item. Leave the "none" for this and all subsequent items if no more items required
Now dose - optional unless you have the same medication in two or more doses
Now the form = e.g. tablet, capsule, ointment, cream, gel etc. - only required if more than one form is authorised for you for the same medication.


THIRD ITEM - As for the first item. Leave the "none" for this and item 4 if no more items required
Now dose - optional unless you have the same medication in two or more doses
Now the form = e.g. tablet, capsule, ointment, cream, gel etc. - only required if more than one form is authorised for you for the same medication.


FOURTH ITEM - As for the first item. Leave the "none" for this if no more items required
Now dose - optional unless you have the same medication in two or more doses
Now the form = e.g. tablet, capsule, ointment, cream, gel etc. - only required if more than one form is authorised for you for the same medication.


If you are not collecting the prescription yourself please supply the name of the person (or chemist) who will be collecting it
Any COMMENTS e.g. reason for ordering early or need for double or triple quantities
If you require more than four items submit this form now then return to this page to order the remainder