Copy of - Repeat Prescription Requests

If you are not registered for online services, you can use this form to request any repeat prescriptions from the Practice. - By sending in this form you are agreeing to receive email and/or sms communications from us. We will only use this information to communicate with you about Penicuik Medical Practice and the service we provide. Please allow 5 working days before collecting your prescription. 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.By sending in this form you are agreeing to receive email and/or sms communications from us. We will only use this information to communicate with you about Penicuik Medical Practice and the service we provide.

Last Updated: 13/09/2024

Your Details

Name *

Date of Birth *

Phone Number *

Email Address *

Medication Required

What medication do you require? *

Additional Comments

This prescription will go to your nominated pharmacy unless you state otherwise below

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

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Copy of - Repeat Prescription Requests

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