Please Note: This form should only be used for patients aged under 16 years of age

This form can be used for you to order repeat prescriptions for your child.

Please note that this route is a secure submission to the surgery but will not bring up your personal details or details of your child's medication. You will need to enter details of your child's medication onto the form including the dosage and quantity you wish to order.

Please take care to enter all details carefully or your order may be delayed.


About Your Prescription

Your Repeat Medication:

Send Your Request

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