Repeat Prescription Request

In future you may wish to consider registering for our Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.

Please note that we endeavour to have your repeat prescriptions ready for collection from the Surgery or Pharmacy up to 3 working days from the day it was requested.

If you are requesting for an item that is not on your repeats it may take longer to be completed.

We require ID from you when collecting a prescription and anyone collecting a prescription on behalf on someone else will need to have given consent.

If your order your repeat prescription on:

Monday  – We endeavour for your prescription to be ready by Thursday after 3pm.

Tuesday – We endeavour for your prescription to be ready by Friday after 3pm.

Wednesday – We endeavour for your prescription to be ready by Monday after 3pm.

Thursday – We endeavour for your prescription to be ready by Tuesday after 3pm.

Friday – We endeavour for your prescription to be ready by Wednesday after 3pm.

Please take Bank Holidays into account and allow us an extra 48 hours when requesting your prescriptions. 

If you would like to submit your repeat prescription request, please use this form.

Repeat Prescription Request - Birchwood Surgery

Repeat Prescription Request - Birchwood Surgery

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Medication Required

Please read all sections carefully before completing this form - if you do not understand or cannot read something, a receptionist will gladly help you.
Item Description
Strength/Dosage
Quantity
Please explain why you are taking this medication – Please note that “I have run out” will no longer be accepted by the Doctor.
Have you had the medication listed above before? *
Have you been prescribed this medication within the last 18 months? *
Please complete an eConsult or make an appointment to see a doctor.
Are you requesting this medication to use for a different purpose than originally prescribed? *
Please complete an eConsult or make an appointment with a GP.
Have you recently been prescribed this by the hospital? *
Please check with the receptionist that we have received the supporting hospital letter. Hospital letters can take up to 4 weeks to be sent to us. Please wait for us to receive the documentation before requesting it, your request will be refused without it.

T&C's

Please be aware: If this form has not been completed correctly and in full, the doctor may reject your request.

Completion of this form does not automatically guarantee that your request will be approved, nor does it guarantee that it will be done on the same day.

Please note that we do not take medication requests over the phone.

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