Repeat Prescription Request

Electronic Prescription Service (EPS)

We are asking all patients to register with their pharmacy for the Electronic Prescription Service (EPS). Please then order prescriptions via your pharmacy. Alternatively you can also order in writing to the surgery.

Request a Repeat Prescription

If you do not have a Systm Online account, you can use this form to request any repeat prescriptions from the Practice.

This helps the practice in terms of time and efficiency in preparing and sending prescriptions.

Due to the increased volume of repeat medication we have to process each day, we are now asking for 5 working days notice prior to collection of prescriptions.

In future you may wish to consider registering for our Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.

* = Mandatory field

About You

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Medication Required

Item Description

Strength

Quantity

Additional Comments

I have nominated a pharmacy and will arrange my collection from the pharmacy.

I have left a self-addressed envelope at reception and would like my prescription posted to me.

Electronic Prescription Service (EPS)

The Electronic Prescription Service (EPS) is a NHS service that allows us to send your prescription(s) directly to your chosen pharmacy. This paper-free prescription service means that you do not have to come into the surgery to collect your prescription. We encourage all patients to register for this free service.

Would you like to register for EPS? *

Yes

No

I've already registered

EPS Registration

I would like to have my prescription sent electronically.

My chosen Pharmacy is: Please select a pharmacy... Peartree Pharmacy, 110 Peartree Lane Codicote Pharmacy, 123 High Street Boots, 65 Moors Walk Boots, 31 Cole Green Lane The Village Pharmacy, 62 High Street Tesco, Mount Pleasant Waitrose, Bridge Road Lloyds Pharmacy, 9 Shoplands Lloyds Pharmacy, 84 Haldens Sainsbury's Pharmacy, 44 Church Rd Boots, 126 Peartree Lane Boots, 43-45 Queensway care2homes Pharmacy, The Polaris Centre Boots, 47 Town Centre Boots, 17 Bircherley Green Boots, The Howard Centre Other

Not sure what your closest pharmacy is?

Use the NHS Find a Pharmacy tool.

Other

Pharmacy Name: *

Pharmacy Address: *

Pharmacy Postcode: *