Repeat Prescription Request

NHS App

The NHS App is a simple and secure way to access a range of NHS services on your smartphone or tablet. Order repeat prescriptions – see your available medicines, request a new repeat prescription and choose a pharmacy for your prescriptions to be sent. Click here for Information & Download

Repeat Prescription Request Form

Use this form to request repeat prescriptions from the Practice. Please allow 2 working days before collecting your prescription.
The easiest way to order repeat prescriptions is by using your NHS account (through the NHS website or in the NHS App). This account shows you all your repeat medicines and dosage and you can choose the ones you need. If you don’t have a nominated pharmacy, you can view a prescription barcode in the NHS App and present this to a pharmacist to collect your medicine without having to collect a paper prescription. View Your Prescriptions in the NHS App
Full Name(Required)
First Last
Date of Birth
Phone Number(Required)
Email Address(Required)
Home Address(Required)
Medication Required
1st item required
2nd item required
3rd item required
4th item required
5th item required
6th item required
7th item required
8th item required
9th item required
10th item required
Additional Comments
- I have nominated a pharmacy and will arrange my collection from the pharmacy.
What happens to my information?
Personal and medical information about patients registered at Peverell Park Surgery is primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you. We sometimes use accredited suppliers for our communication with you (please refer to our Privacy Policy), for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols. To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.
Consent(Required)
- I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.
Comments
This field is for validation purposes and should be left unchanged.

29474

Peverell Park Surgery & University Medical Centre

Repeat Prescription Request

Repeat Prescription Request Form

Medication Required

What happens to my information?

Check out our CQC report

Peverell Park Surgery & University Medical Centre

Repeat Prescription Request

Repeat Prescription Request Form

Medication Required

What happens to my information?

Check out our CQC report

Privacy settings

With the slider, you can enable or disable different types of cookies:

This website will:

This website won't:

This website will:

This website won't:

This website will:

This website won't:

This website will:

This website won't: