Prescription Order Form

Patient Details

Full Name (Mandatory Field)

Date of Birth (Mandatory Field)

Your Email (Mandatory Field)

Daytime Tel (Mandatory Field)

Your GP (Mandatory Field)

Your prescription will be ready for collection at the front desk on the ground floor of the clinic. Please allow a minimum of 48 hours before collection. Please note prescriptions ordered on a Friday will only be available for collection from the following Monday.


To provide us with your prescription details you can download our form and upload it to here or alternatively fill out the details below.

Click here to download our form. To upload you prescription order, add your file here

You may request up to twenty separate items. Enter each drug and strength on your prescription. Untick the 'Required' box if you do not require the item this time.

Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending.

  Drug Quantity and/or Strength
e.g. 1mg once a day
1. required
2. required
3. required
4. required
5. required
6. required
7. required
8. required
9. required
10. required
11. required
12. required
13. required
14. required
15. required
16. required
17. required
18. required
19. required
20. required


Please do not include medical problems here - these should be discussed with your doctor


Monday – Friday 8.00am to 5.30pm
Saturday 9.00am – 12.00pm
Sundays & Bank Holidays – Closed

Monday – Friday 9.00am to 5.00pm
Saturday 9.00am -12.00pm – Emergency Walk in Clinic Only (No Appointments)
Sundays & Bank Holidays – Closed