If your doctor agrees, a repeat prescription may be obtained by:

1) Fax 0161 434 9931.

2) Written request, enclosing a stamped addressed envelope.

3) Personally at reception.

4) Using the request form below.

Security note: Electronic transmissions on the Internet are not always secure and theoretically it is possible for the details emailed from this form to be intercepted by a third party. If you have any concerns, we advise you to use one of the other methods detailed above.

REPEAT PRESCRIPTION REQUEST Name: * Address: * Date Of Birth: * Contact Tel No: Email Address: * For each drug requested all fields must be completed Drug Strength Dosage eg. Lansoprazole 30mg 1 daily Collection from surgery Delivery SELECT ONE Boots Peak Pharmacy Sterling Cockers Lancewise Llyods * Compulsory Fields If there is a problem with your request we will contact you by email. If we have to contact you this will delay your prescription. Please only request medication that is on your repeat slip. If you are requesting more than 5 items further requests will have to be submitted.

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