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

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

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 2017
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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