Please note this is not a secure form.
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.
 

Patients Name *   Date of Birth *     Address     Contact Tel.*     Your Doctor Select your usual Doctor Dr Stubbings Dr Heaf Dr Wallace Dr Luckhurst Dr Stewart     Please select where you want to collect your prescription Collect from the surgery Lloyds - Garden City Lloyds - Village Sainsburys   * You must provide this information.            Item Description  Quantity        (e.g. Paracetamol) (e.g. 100)       Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8     * Not for medical problems *     Comments about this Prescription

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