Repeat Prescription Request

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. Information & Download

Repeat Prescription Request Form

If you do not have a Patient Access account, you can use this form to request any repeat prescriptions from the Practice. Please allow 2 working days before collecting your prescription. In future you may wish to consider registering for our Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.
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.
Email
This field is for validation purposes and should be left unchanged.

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Peverell Park Surgery

Monday
08:00 to 18:00
Phones open at 08:00 / Doors open at 08:30
Tuesday
08:00 to 18:00
Phones open at 08:00 / Doors open at 08:30
Wednesday
08:00 to 18:00
Phones open at 08:00 / Doors open at 08:30
Thursday
08:00 to 18:00
Phones open at 08:00 / Doors open at 08:30
Friday
08:00 to 18:00
Phones open at 08:00 / Doors open at 08:30
Saturday
CLOSED
Sunday
CLOSED

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Peverell Park Surgery & University Medical Centre

Repeat Prescription Request