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Repeat Prescriptions

The Nook and Hartfield Surgeries are dispensing practices. The majority of our patients (dispensing) can collect their medication at the surgery. Unfortunately if you live with 1 mile of a chemist by law we are unable to dispense your medication and you will need to take your prescription to a Chemist. You can request repeat prescriptions in person, by post or by filling in the contact form on the website. Please allow 48 working hours before collection for all patients.

To save you from queuing at the counter we also have a locked and secure box in the foyer of both surgeries where repeat prescriptions can be left.

Note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of ordering a repeat prescription.

To Save Your Details for Future Use:
Follow the steps below to create a new profile:
Step 1: Leave the words "New Profile" in the Choose a Profile drop down list

Step 2: Tick the box "Would you like your details remembered on this computer for a future visit?".

Step 3: Fill in your details and the required medication in the relevant boxes

Step 4: Press the Submit button.
As well as sending the request to us by email, your details will now be retained on the computer you are currently using for future use.

The next time you want to order a repeat prescription, click on the Choose a Profile drop down list and select the relevant patient name.
The form will then be pre-populated with the information that was saved against that persons name when the profile was created or last amended.

Notes:
1) If you change your details in the future and you want the system to save those changes - make sure you put a tick in the box "Would you like your details remembered on this computer for a future visit?", before you press the Submit button

2) You can save the details for as many members of your household as you like

3) If you do not want other users of this computer to see your prescription details then DO NOT put a tick in the box "Would you like your details remembered on this computer for a future visit?"

4) If you want to delete a profile, select the patient name in the Choose a Profile drop-down list, then click on the words "Delete profile for XYZ [Patient Name]"

Please ensure that the patient completes all fields marked with an *

Choose a Profile*

Would you like your details remembered on this computer for a future visit?:
(Also tick this box if you would like to save any changes to your profile)

Patient Name*

Address Line 1

Address Line 2

Town

Post Code*

Daytime Telephone*

Patient Date of Birth (dd/mm/yyyy)*

Please choose your preferred point of collection*

If you choose a chemist as the preferred point of collection then you will need to supply us with a stock of stamped envelopes addressed to them so that we can post the completed prescription for processing.

Medication

Please note that information sent is not encrypted.
You may request up to ten separate items. Enter each drug and strength on your prescription.

Medication (Drug Name)		Strength/Dosage (e.g. 1mg once a day )	Required

10.

Comments

Only comments relevant to the ordering of your repeat prescription should be entered here. Any medical problems should be discussed directly with your doctor

Also, if your choice of chemist is not listed in the Preferred Point of Collection list above, please enter the details here

-Enter Your Comments Here (Optional)-

Please Note: that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of ordering a repeat prescription.