On-line repeat prescriptions

• All requests for regular, repeat items received by 12pm will be processed the same day and will be available for collection from the Surgery by 4:00pm the same day.
• Patients should complete a consent form at the appropriate pharmacy before they can obtain their medication at their chosen destination.
• If your prescription is collected by a chemist please allow more time before collecting from the chemist in order to ensure your medication is in stock.

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, but provisions have been taken to protect the data

  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 Address Post Code Date of birth

  Other contact details email address Home telephone no. Other / Mobile

  Prescription requests 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   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             We recommend you print off and keep a copy of the repeat prescription order which pops up after the submit button is pressed