On-line repeat prescriptions

On-line repeat prescriptions

• NB: This form is to be used for repeat items only (items that appear on the right hand side of your prescriptions).
• Items not on your repeat list will need to be requested following consultation with your GP.  Please see our March 2011 newsletter for the recent changes to our Practice Prescribing Protocol.
• If your prescription is collected by a chemist please allow 3 working days before collecting from the chemist in order to ensure your medication is in stock and has been dispensed (see table).
• Patients should complete a consent form at the appropriate pharmacy before they can obtain their medication at their chosen destination.

DISCLAIMER - PLEASE READ

• To use this system, you will have to enter information about yourself that will be sent to us across the internet.
• This e-form information is not encrypted, but will be no less secure than a normal email.  We can not guarantee that this information will not be seen by others.
• An alternative and more secure way of ordering your repeat medication online is to sign up to EMIS Access (which also allows you to book appointments online).  Please send us a message using our contact form if you would like to be signed up to this service.

• Your personal details Your Doctor Please select Dr Balfour Dr Corfield Dr Dolman Dr Hughes Dr Jackson Dr Llewellyn Jones Dr Mallick Dr Montagnon Dr Ormandy Dr Strawford Dr Sylvester Dr Webb Dr Hazlewood Other Patient No (if known) Full name Enter Name Address Enter Address Post Code Enter Postcode Date of birth Enter DOB

  Other contact details email address Enter EmailInvalid format Home telephone no. Enter Telephone Other / Mobile

  Prescription requests (repeat medications only) Item 1 Strength Qty Item 2 Strength Qty Item 3 Strength Qty Item 4 Strength Qty Item 5 Strength Qty Item 6 Strength Qty Item 7 Strength Qty Item 8 Strength Qty Item 9 Strength Qty Item 10 Strength Qty Item 11 Strength Qty Item 12 Strength Qty Item 13 Strength Qty Item 14 Strength Qty Item 15 Strength Qty   Additional information

  Collection point Your prescription will be available for collection from the surgery. However if you have completed an agreement form with a pharmacy to have your prescriptions sent direct to them for collection, it will be sent there automatically. If you have not yet completed an agreement and wish to collect your medication directly from one of the following pharmacies: Glastonbury Pharmacy, Feversham Lane, Glastonbury Boots Chemist, Vine Health Park, Hindhayes Lane, Street Alliance Pharmacy, 2 High Street, Glastonbury Boots Pharmacy, 39 High Street, Glastonbury Street Pharmacy, High Street, Street Sainsburys Supermarket, Street Please complete the necessary paperwork, which can be obtained either from the surgery, or at the pharmacy of your choice. Once this form has been received by the surgery, all future requests will be sent to that destination, unless you advise us that you wish to cancel the agreement.

  Acceptance Please confirm your acceptance of Glastonbury's terms & conditions for online repeat prescription requests by inserting your name in the box below Accepted by Enter Name   Your Full Name is missing Your Address is missing Your Postcode is missing Your Date of Birth is missing Your Email Address is missing Your Email Address format is invalid Your Home Telephone is missing Your 'Accepted By' name is missing          We recommend you print off and keep a copy of the repeat prescription order which pops up after the submit button is pressed