Beechwood Medical Practice

We can only accept Repeat Prescription requests for items listed on your paper Repeat Prescription form, unauthorised items cannot be dispensed.

If you would like this form to retain previously entered information you will need to ensure that your browser preferences are set to enable the use of cookies.


Repeat Prescription Form

 
Patient Name:
Address:
Date Of Birth:
Home Telephone:
Patient Email Address:
       
  Item Description Strength Dosage
Item 1:
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Item 9:
 
Pick-Up Point:
   
Additional Information:
 
 
Security Issues
 
The practice has no control over internet problems and cannot be held responsible for any delay in the delivery of emails or any technical failure of the service.  The information you submit will be treated in the strictest confidence.  However, we cannot guarantee the security of global internet/email systems.  This means that it is possible (although unlikely) that your request may be read by someone other than yourself or us.  If you are concerned about this possible loss of privacy please request your prescription written request.

 

Please allow two working days for your prescription to be prepared from the date of the confirmation email. Collect your prescription from the pick-up point you entered on the form above.