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.

Repeat Prescription Form

Patient's Name *
Date of Birth *
Email Address We are hoping to update 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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February 2014 - FLU VACCINES NOW IN STOCK - IF YOU ARE OVER 65 OR ARE IN ANY OF THE RISK GROUPS (see link below to see if you are eligible), PLEASE MAKE AN APPOINTMENT TO SEE VAL AT ANY OF OUR FLU CLINICS.
     
     
Web site designed and maintained by Val Edwards, Culloden Medical Practice 2014
Last updated : February 1, 2014