Request a Repeat Prescription

Contact Form

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Required fields are marked *

*Surname:

*First Name:

*Date of Birth:

*House Number and Street:

District

*Town/City:

*Postcode:

*Telephone Number: (or none)

*E-mail:

Usual GP:

Please select your preferred collection method *

Collect from Loudwater surgery
Collect from MOSS Chemist
Collect from TESCO
Collect from AQSA
Collect from RYEMEAD
MOSS Deliver
RYEMEAD Deliver
Allow friend or relative to collect (please give name below)

Name of friend/relative nominated to collect prescription

Drug 1

* Name of drug

* Dose

Number of times taken a day (if applicable)

Drug 2

Name of drug

Dose

Number of times taken a day (if applicable)

If you require more than two items on your prescription please fill in the addtional items in the area below.

Additional Drugs
Name of drug/Dose/Number of times taken daily

Additional Comments
Please add any additional comments (Please let us know if you are taking any other medication which we have not prescribed, for example medicines bought from your chemist, or prescribed by someone else)

Please click the submit button to send the form. You should receive a confirmation e-mail once the form has been successfully submitted. If you do not receive an e-mail receipt, your request has not been successfully transmitted to the surgery.

Required fields are marked *

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Back to repeat prescriptions

How long does it take to get a repeat prescription?

It takes 2 working days for your repeat prescription to be prepared but may take longer if a doctor needs to check something directly with the patient or another clinician.

For more general information on repeat prescriptions please see our repeat prescriptions page.