On-line repeat prescriptions
You can collect your prescription from the surgery or arrange for your pharmacy to collect it for you once you have signed their consent form.
Repeat prescriptions will be available for collection at the surgery after two working days following your order.
Disclaimer
PLEASE READ
To use this system, you will have to enter information about yourself that will be sent to us across the internet.
This e-form information is not encrypted, but will be no less secure than a normal email.
We can not guarantee that this information will not be seen by others.
Your personal details
Your Doctor
Please select
Dr Timothy Walker
Dr Christopher Norris
Dr Geoffry Sharp
Dr Fiona Knight
Dr Steve Holmes
Dr Louise Absom
Dr Dan Perkin
Other
Patient Number (if known)
Full Name
Enter Name
Address
Enter Address
Post Code
Enter Postcode
Date of Birth
Enter DOB
Other contact details
E-mail address
Enter Email
Invalid format
Home telephone no.
Enter Telephone
Other / Mobile
Prescription requests
Item 1
Strength
Qty
Item 2
Strength
Qty
Item 3
Strength
Qty
Item 4
Strength
Qty
Item 5
Strength
Qty
Item 6
Strength
Qty
Item 7
Strength
Qty
Item 8
Strength
Qty
Additional information
Collection:
I will collect from:
Please select
The Park Medical Practice
Boots (Townsend)
Boots (Park Surgery)
Evercreech Pharmacy
Evercreech Dispensary
Acceptance
Please confirm your acceptance of The Park Medical Practice's terms & conditions for online repeat prescription requests by inserting your name in the box below.
Accepted by
Enter Name
Your Full Name is missing
Your Address is missing
Your Postcode is missing
Your Date of Birth is missing
Your Email Address is missing
Your Email Address format is invalid
Your Home Telephone is missing
Your 'Accepted By' name is missing
We recommend you print off and keep a copy of the repeat prescription order which pops up after the submit button is pressed
