Repeat prescription form - Firrhill Medical CentreFirrhill Medical Centre - 165 Colinton Mains Drive, EH12 9AF

Repeat prescription form

CORONAVIRUS INFECTION CONTROL

To reduce the risk of infection, it will no longer be possible to collect your prescription in person.

Please write the pharmacy, you would like your prescription to be sent to in the “any other information box”.

 Due to the current pressures on the Practice and local pharmacies you should allow 7-10 days before collection from your pharmacy or in some cases for delivery.  We will not be processing prescriptions early so only request a maximum of 2 weeks before it is due.

Thank you

You can use this form to order repeat prescription medicines.

If you need to order more than six items at a time, you can submit another form after sending this one in.  Once you press send the form will clear all your entered details and the information will have been received by the Practice, you will receive email confirmation from our clinical inbox that this has been received.  Please note that if you have already contacted the practice using  your email address, by eConsult or by using the same email address for 2 or more patients you will not receive a separate acknowledgement.

    Your Name (required)

    Address (required)

    Town / City (required)

    Postcode (required)

    Telephone

    Email address (required)

    Date of birth

    Medication name Drug dose Drug quantity

    Any other information

    CONFIDENTIALITY – TERMS AND CONDITIONS

    The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients transmissions.

    By clicking Send you agree to the terms and conditions of using this service.