Prescriptions

//Simple, Safe and Efficient

Order your prescriptions using this form

    Personal details

    Address

    Exemption

    Are you exempt from prescription payments? Tick "NO" if you pay for your prescriptions or "YES" if you do not.

    The NHS regularly carries out counter fraud checks when patients say that they are exempt from prescription charges. The NHS also requires us to ask you for evidence that you are exempt from paying prescription charges for some types of exemption and to notify them if we do not see this evidence. The NHS can fine you if you wrongly claim to be exempt from paying for your prescriptions even if it is a mistake.

    Please upload proof if you have not already done this previously


    Surgery details

    Prescription details

    Please write down the Name, Strength, Form and Quantity of each medicine you require e.g. Atenelol Tablets 25mg x 28. Only order what you need.

    Please sign here

      Personal details

      Address

      Exemption

      Are you exempt from prescription payments? Tick "NO" if you pay for your prescriptions or "YES" if you do not.

      The NHS regularly carries out counter fraud checks when patients say that they are exempt from prescription charges. The NHS also requires us to ask you for evidence that you are exempt from paying prescription charges for some types of exemption and to notify them if we do not see this evidence. The NHS can fine you if you wrongly claim to be exempt from paying for your prescriptions even if it is a mistake.

      Please upload proof if you have not already done this previously


      Surgery details

      Prescription details

      Please write down the Name, Strength, Form and Quantity of each medicine you require e.g. Atenelol Tablets 25mg x 28. Only order what you need.

      Please sign here