Main menu:

Park Leys Medical Practice

Repeat Prescription Request

Please note that we can only process requests for prescriptions for patients registered with Park Leys and if a Doctor has authorised repeats to be issued.

If you require new medication, a change to medication or issue of medication that has not been put on repeat by a Doctor then you will need to speak to or see a Doctor before your request can be processed.

Please allow us 2 working days before collecting your prescription or medication to ensure that we have had time to check and process your request.

Name*:

Email*:

Date of Birth*:

Telephone Number*:

Please give full details of Medication required*:

Collect*:
Prescription from Keresley Green Medical Centre
Prescription from Bennetts Road North
Prescription from Fillongley Surgery
Medication from Fillongley Surgery (Fillongley patients only)
Medication from Chemicare
Medication from Shires
Medication from Flemmings
Medication from Gohills
Medication from Boots (Ricoh)
Medication from Boots (Jubilee Cres.)
Medication from Boots (Moseley Ave)
Medication from Wills
Medication from Imperium
Other (specify in additional notes below)

Additional Notes:

Conditions of Processing:

This message is processed on the basis that the patient consents for this information to be transmitted by email and accepts that confidentiality cannot be guaranteed.

I agree I do not agree

Last Updated 22nd May 2009