36 Parkstone Road, Poole, BH15 2PG  Telephone (01202) 682174
























REPEAT PRESCRIPTION
REQUEST FORM

 

It is now possible for us to process your repeat
prescription requests online via the form below.

Please only apply for prescriptions which you have had before,
or have regularly - any request for different of new drugs should
be done via Dr. Newman.

 
Full Name :              

Date of Birth :            -- dd/mm/yy

Telephone number :  

Address :

                                              

Where would you like to collect you prescription from?
Please select as appropriate from the drop down box





Please state the repeat prescription items that you require. Please include the drug name and the dose eg. Asprin 75mg


                       


Please allow at least 1 full working day before collection from the surgery and 2 full working days before collection at the pharmacy.