Repeat Prescription Request

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Please use the form below to submit a prescription request. Please allow 24 to 48 hours for your request to be processed.

Personal Details

Full Name: *

GP Surgery Name: * We may need to contact your surgery if required

Your DOB: *

Your Phone Number: *

Your Email Address: *

How Would You Like To Send Your Request?

How Would You Like To Send Your Request?: *

Manual Input

Medication Required

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

Please note: Items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Item Description *	Strength *	Quantity *	Action

Additional Comments:

Collection Method: *

Collect from Pharmacy FREE

Pick up from Kennington Pharmacy during opening hours

Local Delivery FREE

Free delivery within Kennington area (OX1 5** postcodes)

Royal Mail Delivery £3.50

Secure postal delivery anywhere in the UK

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.