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  Repeat Prescription Request
  
PERSONAL DETAILS PRESCRIPTION DETAILS
Name or Initials
   
Date of birth or Computer number
Contact phone number
Collect prescription at...
   
Select a doctor...
Drug Names Strength
 Add any further details below...
     
Store my details on this computer

    

 

 

                                          Prescription Security
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. You can use your computer number (found on your prescription slip) and your initials if you wish to increase the level of confidentiality. Otherwise please feel free to use our normal repeat prescription service.