Online Prescriptions

PATIENT NOTICE - August 2008
We are now offering a new way of ordering repeat medication online via Emis Access.
In order to sign up for this new service you will need to obtain a registration letter from the surgery and register as a user.

Please note: To give patients further opportunity to register we have extended the date on which we will remove this form until Friday 31st October. Please ensure that you collect your PIN No and register as soon as possible.

Online Prescriptions - Non secure - See Disclaimer

To help our staff we must ask that you provide the correct name and strength of our medication as it appears on your repeat prescription.

Patients Name *

* You must provide this information

Date of Birth *

Address *

Contact Tel.

Your Doctor

Item Description

Quantity

Strength

(e.g. Paracetamol)

(e.g. 100)

(e.g. 500mg)

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Collection Method:
I will collect from:

Please allow a full 2 working days for collection of your on-line prescription request.

* You must provide this information

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<< type blue word into this box

Additional Comments