Prescription Order Form

We have been advised by the Royal Pharmaceutical Society that during the Covronavirus Pandemic, it is taking 7 days for pharmacies to process repeat prescriptions. Please take this into account when ordering and please only order what you need.

This form is for ordering prescriptions only. No other queries will be dealt with by email.

Item	Item description	Qty.	Strength
1
2
3
4
5
6
7
8
If you wish to order more than 8 items, please complete a separate form. Please allow two full working days between sending this email and collecting your prescription/medications.

Please specify how you would like to obtain your medication:
A: Practice Collection
B: Collect my medication from a chemist
If you have chosen B, please select a chemist from the list below

C: Have my medication delivered by a chemist
If you have chosen C, please select a chemist from the list below
OPTION C IS ONLY AVAILABLE FOR PATIENTS WHO HAVE MADE A DELIVERY ARRANGEMENT WITH THE CHEMIST