Parley Cross Pharmacy

Repeat Prescriptions
Repeat Prescription Form - Private Prescription Quote Form

We can order your repeat prescriptions from your doctor for you; and have it dispensed ready for you to collect or simply wait for it to be delivered.

To join this fantastic service simply phone the pharmacy on 01202 573 191 to arrange to sign the consent form and leave your repeat order form at the pharmacy.

If you have already signed up just leave your details below and order your medicines. We need five working days before you can collect your medicines or have it delivered. For more urgent requests please phone the pharmacy.

Please Note: We are also able to accept prescriptions electronically using the secure NHS Electronic Transmission of Prescriptions Programme (ETP); ask us for details.

This service is only available to patients of the surgeries in the list on the form below, who have a valid, up-to-date, repeat prescription.

Repeat Prescription Request Form

First Names:
Last Name:
Date of Birth: (dd/mm/yyyy)
Address:
Phone Number:
Email Address:
Surgery:
Please tell us what medication you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name Strength

If you require more than 8 items, please submit another request.
Comments (any comments that you may have about this service)

CONFIDENTIALITY - TERMS AND CONDITIONS
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The Pharmacy accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above and understand that by ticking this box I give my consent for Parley Cross Pharmacy to order, pick up and dispense this repeat prescription.
 

Private Prescription Quotes Form

We charge competitive prices for dispensing private prescriptions.
Contact us for a quote - 01202 573 191 or complete the form below -

Name:

Telephone No:

Email Address:

Details of
prescription required:


 
Produced by Oldroyd Publishing Group for Parley Cross Pharmacy back to top of page