THIS SERVICE WILL SOON BE WITHDRAWN AND REPLACED WITH ONLINE PRESCRIPTIONS - PLEASE REGISTER YOUR EMAIL ADDRESS BELOW FOR ONLINE SERVICES

Register for Online Appointments/Prescriptions (provide name, D.O.B. and email address)

Please Note : This form is sent to us via computers that do not belong to the NHS in a non-encrypted format. Complete confidentiality for this type of repeat prescription request can not be guaranteed. If you have an issue with this please feel free to use our normal repeat prescription service, or register for online services.

Repeat Prescription Form

Patient's Name *
Date of Birth *
Email Address We are currently updating our current Repeat Prescription system. If you are interested in registering for this service, please provide the Practice with your up to date email address and we will contact you with registration information. Thank you.
Address *
Contact Tel: *
Date
Your Doctor *

* Means you must provide this information
Please select from the list below where you want to collect your prescription:

Please give all drug names in full, including dosage, strength as described on your previous prescriptions. You should only use this form if you are requesting medicines that are on your repeat medication form, please either hand in, post or fax your non-repeat request items separately.

 
Item Description
(e.g. Paracetamol)
Quantity
(e.g. 100)
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10

 Comments about your prescription * Not for medical problems *

Please give 48 hours notice, excluding week-ends for collection at the Practice.  For collection at Culloden Pharmacy please allow 3 full working days and for other Pharmacies please allow 5 working days.  For Lloyds Pharmacies please also provide a stamp-addressed envelope to the Lloyds Pharmacy you have chosen.

Important notice
This request form is for repeat medication only.
The Practice will be unable to respond to any other messages or queries.

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The Flu Season is here! To make an appointment, we ask that you "Register" for Online Services . This means that this year, you can make your own appointment(s) for the Flu Vaccination. Please contact the Practice as soon as possible, and get registered for this service.
     
     
Web site designed and maintained by Val Edwards, Culloden Medical Practice 2014
Last updated : September 24, 2014