Repeat Prescriptions

We have an arrangement with the following surgeries to dispense repeat prescriptions to patients -

Wrythe Green Surgery
The Chesser Surgery

This service is only available to patients of these surgeries who have a valid, up-to-date, repeat prescription.

First Names:
Last Name:
Date of Birth:	(dd/mm/yyyy)
Address:
Phone Number:
Email Address:
Surgery:

Please tell us what medication you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip or pharmacy label which is on your medication. It would help tremendously if you can type in upper case [CAPITAL LETTERS].

Drug Name	Strength	Quantity

If you require more than 8 items, please submit another request.

Comments (any comments that you may have about this service)

CONFIDENTIALITY - TERMS AND CONDITIONS:

Whilst this form is secured using the Hush Secure Forms service, the internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The pharmacy accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

The information that is being submitted by the forms on this site using Hush Secure Forms is secure, because it is encrypted prior to leaving the site, and is being submitted to a secure page.

I accept the terms and conditions above

I can't see a padlock - is this secure?