Rose Valley Medical Centre

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Repeat Prescription Ordering


This page only deals with medications that are already on your repeat prescriptions slip. Please make sure that you have 'repeats' left on the drug you are requesting. If not, contact the surgery as you may have to see the Doctor or Nurse for re-authorisation.

Repeats form:

Please complete the form so that the drug names and doses precisely match those written on your repeat prescriptions slip:

Patient Details:

Firstname (1st 3 Chars): *

Surname (1st 3 Chars): *

Date of Birth (dd/mm/yyyy): *

 /   / 

Collection Point:  *

Drug Name: *


Special Instructions:

Terms & Conditions:

By clicking on the check box you are confirming that, with regard to this facility, you agree with the Terms and Conditions for its use, you consent to the practice collecting and storing your data from it and you give your consent for the practice to contact you (by email, text message and/or telephone) about it.


How do I complete this
form ?

Enter your personal details and your repeat requests into the fields. The [tab] key can be used to move between fields. When you have finished, press the 'Continue' button to move to the confirmation page.

Prescription Collection:

Collection from Surgery: Allow at least 2 working days for us to process your request.
Collection from Pharmacy: Processing time may be up to 2 working days as it is dependent on the pharmacy.

Why do you need my
Email Address ?

We use this to send you a confirmation of your prescription order. We do not store your address on our system after the email has been sent. If you do not require a confirmation email simply leave this field blank.

What can I use the
Special Instructions for ?

If you have any instructions for us regarding your order, please tell us. However, this box should not be used for medical enquiries regarding your prescription.

What does
'Auto Complete' do ?

If you have used the form before, 'Auto Complete' automatically fills in your personal details using the information from the last time you completed the form. If more than one person uses the computer for ordering repeats, pressing 'Auto Complete' again will cycle onto the next person's details. The process is cyclical, so it will return to the original persons details when all entries have been displayed.

I have more than ten drug
requests. How do I submit
the extra requests ?

If you have more than ten drug requests, you will be given the chance to enter them once this form is confirmed and saved.

Other Notes:

All fields marked with * are mandatory. Your Drug Names and Doses can all be found on your repeat prescription request slip.