Repeat Prescription

To request a repeat prescription, please enter your personal details below, followed by the name, strength and quantity of medication you require. Please allow at least 48 hours before visiting your collection point.

We can only process requests for repeat prescriptions – if you require a new medication you will need to book an appointment or speak to one of our doctors on the telephone.

1 Your Details

Please provide in the format dd/mm/yyyy
This will allow us to locate you quickly on our Patient Database.

2 Your Address

3 Your Contact Details

4 Prescription Details

Medication Required


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


© Dordon and Polesworth Group Practice 2018
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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