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Javascript DHTML Tree Menu Powered by dhtml-menu-builder.com On-line Prescription Request
     
 
    ON-LINE PRESCRIPTION REQUEST
   
Important Information - Please Read

You can collect your prescription from the surgery or arrange for your pharmacy to collect it for you once you have signed their consent form.

Repeat prescriptions will be available for collection at the surgery after two working days following your order.

Disclaimer - please read. To use this system, you will have to enter information about yourself that will be sent to us across the internet.

This e-form information is not encrypted, but will be no less secure than a normal email.

We can not guarantee that this information will not be seen by others.

PLEASE TAKE CARE TO ENSURE THAT YOU CLICK ON THE SUBMIT BUTTON ONCE YOU HAVE COMPLETED THE FORM, AND THAT YOU GET AN ACKNOWLEDGMENT THAT YOUR SUBMISSION HAS BEEN SUCCESSFUL. THE SYSTEM IS DESIGNED TO CONFIRM YOUR REQUEST HAS BEEN SUBMITTED, IT IS ALSO DESIGNED TO GIVE YOU A MESSAGE IF, FOR ANY REASON, IT HAS NOT BEEN SUCCESSFUL. Some patients have clicked on the print button to keep a copy of their request, but fail to click on SUBMIT which means the request has not been sent or received by the surgery.
Your personal details
Your Doctor
Patient Number (if known)
Full Name Enter Name
Address Enter Address
Post Code Enter Postcode
Date of Birth Enter DOB
Other contact details
E-mail address Enter EmailInvalid format
Home telephone no. Enter Telephone
Other / Mobile
Prescription requests
Item 1 Strength Qty
Item 2 Strength Qty
Item 3 Strength Qty
Item 4 Strength Qty
Item 5 Strength Qty
Item 6 Strength Qty
Item 7 Strength Qty
Item 8 Strength Qty
Additional information
Collection Point
I will collect from:
Acceptance
Please confirm your acceptance of Grove House Surgery's terms & conditions for online repeat prescription requests by inserting your name in the box below.
Accepted by Enter Name
  Your Full Name is missing
Your Address is missing
Your Postcode is missing
Your Date of Birth is missing
Your Email Address is missing
Your Email Address format is invalid
Your Home Telephone is missing
Your 'Accepted By' name is missing
 
 
 
We recommend you print off and keep a copy of the repeat prescription order which pops up after the submit button is pressed
   
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