Repeat Prescription Form – Culloden Medical Practice

Please be aware, that your local Pharmacy can help with certain medical conditions, therefore avoiding the need to see your GP.

Pharmacists can provide certain medicines and products on the NHS.

If the Pharmacist thinks it is better for you to see your GP, they will ask you to contact the Practice.

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.

Please allow FIVE working days for collection of your prescription at any of the Pharmacies.
Name*
First Last
Address*
Date of birth*
DD slash MM slash YYYY
Contact number*
Email address*
Enter Email Confirm Email
Please select your Preferred Pharmacy or if you would like to collect it from the Practice*
Please ensure you select the correct Pharmacy as this will be updated in your notes for future prescriptions.
You can add up to 12 items on this form. As you type in each item another set of boxes will appear.
Item 1 - eg Atenolol*
Strength 1 - eg 50mg
Quantity 1 - eg 28 tabs*
Item 2
Strength 2
Quantity 2
Item 3
Strength 3
Quantity 3
Item 4
Strength 4
Quantity 4
Item 5
Strength 5
Quantity 5
Item 6
Strength 6
Quantity 6
Item 7
Strength 7
Quantity 7
Item 8
Strength 8
Quantity 8
Item 9
Strength 9
Quantity 9
Item 10
Strength 10
Quantity 10
Item 11
Strength 11
Quantity 11
Item 12
Quantity 12
Strength 12
Comments about your prescription - **Not for medical problems**
Important notice
This request form is for repeat medication only. The Practice will be unable to respond to any other messages or queries.
Please be aware that the Practice will be closed on Monday 6th May , so there may be a delay with the processing of your prescription around this date.
Terms & Conditions
You can request a repeat prescription by completing and submitting an online form. By completing this form you agree to read and accept our terms and conditions
1. Before requesting online repeat prescriptions you will need to register for the service by speaking to our reception staff.
2. The service is provided only to request repeat prescriptions. It is not to be used to request advice or assistance on any other matter.
3. You can only order items listed on the repeat request form attached to your last prescription.
4. If the date for your next review with a doctor or nurse has passed you will be asked to make an appointment.
5. Your prescription will be ready for collection from the surgery two working days after your request has been submitted.
6. Absolute confidentiality is not possible because we cannot guarantee the security of the Internet. If you are not comfortable with this arrangement you may prefer to order your prescription in person or by post.
7. An email confirming your repeat request will be sent to the address you provide on the form on the following page.
8. The practice cannot be held responsible for any delay in receiving your request, nor any technical failure of the system. Please make sure you order repeat prescriptions in plenty of time.

Terms & Conditions