Repeat prescriptions request – Trosnant Lodge Medical Practice

You can request repeat medications using this form.

"*" indicates required fields

Please ensure you complete ALL of the sections marked with an * otherwise the form cannot be sent.

Name*

First Last

Address*

Date of birth*

Contact number*

NHS number (if known)

Email address*

Enter Email Confirm Email

Prescription items

Copy exactly the details from a prescription slip you have received from the practice. Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Please list the repeat prescription items you require

Which pharmacy would you prefer to collect your prescription from?*

Any comments about your prescription **Not for medical problems**

Important notice

This request form is for repeat medication only. The Practice will be unable to respond to any other messages or queries.

Date of request*