Yealm Medical Centre Online

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Request your Prescription
This service allows you to request your repeat prescription online. This saves you having to come into the surgery to drop off your repeat request.

Note: Requests made after 4pm will not be processed until the following working day. Please allow 2 working days from then.

	Please fill in ALL fields
	Please allow 2 working days before collecting your repeat prescription.
	Use the TAB button on your keyboard. DO NOT press enter to go to the next box as this will actually hit the 'request prescription' button and you will be presented with an error message
	You must be a registered patient to use this service.
	You must read and accept the Terms and Conditions of this service by checking the box at the bottom of the form. You will not be able to use this service if you do not agree to the Terms and Conditions.

Please input your details into the form below and click 'request prescription'. Your request will then get sent to us directly at the surgery where we will deal with it as we usually would.

* = Required Field

Forename* Surname* Date of Birth*

Patient Number

Phone Number* E-mail Address* Your Doctor

Please tell us which drugs you require. Please be specific with the name of the drug. If you are unsure, please use the name on the box.

Drug Name*                                   Strength

Collection Point

Comments
If you have any additional comments, please type them below.

I agree to the Terms & Conditions of Service*

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