Repeat prescriptions request – Trosnant Lodge Medical Practice

You can request repeat medications using this form.

Please ensure you complete ALL of the sections marked with an * otherwise the form cannot be sent.
Name*
First Last
Address*
Date of birth*
DD slash MM slash YYYY
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*
DD slash MM slash YYYY
Consent*
I agree to the privacy policy.
By submitting your details you are consenting to providing this information for improving our services to you. The data you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 7 calendar days. Your contact details will not be sold or shared with a third party. I understand I can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website.

Prescription items