Repeat prescription form

Request a repeat prescription

Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. Please allow 48 hours before collecting at the Pharmacy of your choice.

"*" indicates required fields

Repeat Prescription Form

First Name*

Last name*

Email*

Phone*

Date of Birth*

Your preferred pharmacy*

Optional message

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice. e.g. Loratadine 10 mg Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Prescription item 1*

Prescription item 2

Prescription item 3

Prescription item 4

Prescription item 5

Prescription item 6

40535

All fields marked with * are mandatory.

Order your repeat prescription via the NHS app

Did you know you can order your prescription via the NHS app? You can manage your repeat prescriptions easily via the app, it also shows you when the prescription has been signed off by the GP. For more information on the NHS app please click here.

KHC Repeat prescription form

Request a repeat prescription

Repeat Prescription Form

Prescription Items

Order your repeat prescription via the NHS app