Prescription Service

This service is only available to patients of these surgeries who have a valid, up-to-date, repeat prescription.

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.

Do you pay or sign for your prescriptions?

Pay Sign

Do you wish to collect or have your prescription delivered

Collect from pharmacy Deliver to addess above

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 Trayners Chemist to order, pick up and dispense this repeat prescription.

Repeat Prescriptions