You may use this form to request a Repeat Prescription.
Warning: gmail, yahoo, msn and hotmail email addresses. Please enter those email addresses with a double g/y/m/h e.g. ggmail to prevent this form failing to send.
We will only accept requests for prescription items that are listed on your Repeat Prescription counterfoil. The item has to be authorised, i.e. not in need of review by a Doctor, as indicated on the Repeat Prescription request form.
You must include a valid email address so that we can notify you of a problem. Although this form is not encrypted the data is saved on our server and collected via the internet, so it is not 100% secure. If you use your unique "AI code" found on your Repeat Request form (see example) you need only enter the first letter of your surname and forename for security.