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Repeat Prescription Form

Repeat Prescription Form

    Your Details:
    Pharmacy Details:
    Medication Details:
    e.g.: Panadol
    500mg
    3 times daily
    2 tabs
    1 month
    Please Note:
    • Please allow 48 hours for request to be processed.
    • Patients may be asked to attend Dr for review depending on last attendance and current medications requiring monitoring.
    GDPR: We will only use the information you provide us in this form to deal specifically with your request for a repeat prescription and we will not use it for any other purpose.

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