GMS DVC Repeat Prescriptions

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.

First Name

Last Name

Full Address

Date of Birth (dd/mm/yyyy)

Phone

GMS/DVC Number

Medications (include name of medication, dose, duration)

Usual GP

Nominated Pharmacy

I consent to my prescription being sent digitally sent from the practice to my chosen pharmacy.

I acknowledge that it takes up to 48 hours (excluding weekends) to process repeat prescription requests.

I consent to this message being sent electronically to the practice. I have checked that the email address and phone number supplied are correct and consent to receiving medical information via email or text.

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.

GMS/DVC Repeat Prescription Request

Contact

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