Repeat Prescription Request - Fernville Surgery

If you do not have a Patient Access account, you can use this form to request any repeat prescriptions from the Practice.

Please allow 3 working days before collecting your prescription.

Please note that if you wish to order a medication that you have not had within the last six months, you should make an appointment to discuss.

In future you may wish to consider registering for our Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.

Order Medication

Please complete the online form below to request a repeat prescription.

Title

Name

First Middle Last

Date of Birth

Address

Street Address Address Line 2 City Postcode

Contact Number

Email Address

Enter Email Optional Confirm Email Optional

Enter each medication and strength on your prescription

Medication

Strength

Dose

Please click on the + button at the end of each row to add more medications to the list.

Pick Up Point Optional

Additional Notes Optional

Name

First Optional Last Optional

Order Medication

Enter each medication and strength on your prescription

Thank you for your feedback.