Nightingale Surgery    Repeat Prescription Request

Repeat Prescribing Policy

    A prescription can be requested using this form if your doctor has authorised it on the practice's 

    medical information system.   If this is not the case you will be asked to book a routine appointment 

    to see your doctor.   We must also review patients who are taking repeat prescription on a regular basis.  

    You may be informed that review is required, even if the prescriptions have been previously authorised.

 

   Please be aware that this information is transmitted by normal e-mail and is therefore not 100% secure.  

   By completing this form you accept the risk that this information could be obtained and used by an un-authorised party.

    Please allow 2 clear working days to process your prescription.

    Please fill in the form below and click the send button.

    Your prescription may be forwarded to one of the following:- please choose from the table below

Boots Superdrug Alliance Moss (Romsey) Lloyds New Forest Pharmacy (Lyndhurst)
Dispensed at the Surgery ( Dispensing  patients only)
Collected from Reception at the Surgery

Posted to you (please send a stamped addressed envelope)

 

      Name 
      Date of birth (dd/mm/yyyy) 
      First line of Address   
      e-mail address   
      Telephone  
      Fax ( if available) 

    

       Repeat Prescription Request    Please give as much information as possible

     

cj
Copyright © 2002 [Nightingale Surgery]. All rights reserved.
Revised: July 09, 2008.