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GMS/DVC Repeat Prescription Request

Please allow 48 hours for the prescription to be sent to your pharmacy.

If you qualify under the Free Contraception Scheme, please do not complete the form and call reception to arrange an appointment.

By submitting this form you will be sending personal/sensitive information about yourself across the Internet. Please read our privacy statement to discover how we protect and manage your submitted data. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of contacting the practice.

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