Repeat Prescriptions (Registered Patients only)

If you need a repeat prescription, please fill in this form and send it to us by clicking on the box ‘Submit’ at the bottom of the page.

You can also e-mail your prescription request to us at prescriptions@carfaxhealthcare.co.uk. Please make sure you bring a copy of this e-mail with you when you come in to collect your prescription.

Alternatively, you can tick the items you need on the repeat prescription form attached to your last prescription and hand it in to Reception. Your prescription will be ready to collect in 2 working days.

The doctor can only issue repeat prescriptions if he or she regularly reviews your medication so from time to time you will need to make an appointment to do this.

Full Name:

Address:

Date of Birth:

* (dd/mm/yyyy)

e-mail Address:

* (to receive confirmation)

Telephone Number:

(in case of query)

We will send you confirmation by e-mail (to the address provided above).

Medication Required

Drug Name: (on the packet)	Strength: (e.g. mg or mcg)	Dose: (e.g. twice a day)	Quantity: (e.g. 1 month)
*	*	*	*

* Mandatory field

Add additional medication

If you want us to pass your prescription on to the Carfax Street Pharmacy so you can collect your medication from them, please tick this box.

Please note: you cannot use this form for repeat prescriptions for the Oral Contraceptive Pill. You must call in to the Practice for this and it usually requires an appointment.

Important Disclaimer: Please note that any information submitted using this form will be sent to the Practice by an unencrypted e-mail message. This means that someone else outside the Practice could possibly access and read it. Please contact us if you would like to find out about other ways to send us this information.