Repeat Prescriptions

Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. Please allow 4 working days for the preparation of prescriptions.

If you do not have an online account or are having difficulty ordering using Patient Access you can complete the form below and submit your request. This can be used both by Dispensing and non-dispensing patients no matter where you collect from.

Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission. It is important to enter your correct email address failure to do so will result in non-delivery of your request.

Repeat Prescription Request

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Special Medication Request

If you are requesting medication that you have not used in the previous 12 months please give a reason for your request (medical condition the medication relates to)

Collect from *

Please specify Pharmacy name and address *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.

I consent to the practice collecting and storing my data from this form.

I understand additional personal data is provided to the Practice, including IP location and software information.

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Prescription Items

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Woolavington Surgery