Bideford Medical Centre repeat prescription form

Repeat Prescriptions

Security

Sending information over the Internet is not guaranteed to be secure.

We have made attempts to tighten security: When making your repeat request you will not need to enter your name. You will need your Patient Identifier Number on the top left hand side of your Repeat Order Slip. This will make the information you submit less useful to others should it go astray or be intercepted. Once we receive your information it will be handled as confidential medical information; it will not be passed on to any other agencies or individuals - please see our Privacy Statement at the bottom of this page for more details.

Please only use the On-Line Ordering if you accept this risk!

Further Important Information

We can only process drugs that are authorised for repeat prescribing - that means they appear on your up to date repeat slip and you have not been asked to attend the surgery for a medication review.

Please remember we need 48 hours (excluding weekends and Bank Holidays) to prepare and process your request. Please allow an additional working day for it to be dispensed by the pharmacist.

If you are not happy with this risk there are other ways of making a repeat request!

If you are happy with the risk, please use the form below.

Repeat Prescription Form

Please provide the following information. You will need your current repeat order slip for this. * denotes mandatory field

Patient Identifier (this can be found at the top of your repeat order slip):*

Your email address:*

Date of Birth: (Format: DD/MM/YYYY)*
* Safari browser users enter date format: YYYY/MM/DD *

Daytime Phone Number (please enter without any spaces):*

Your Dr:*

Please note:
We are only able to deal with requests for medication on your current repeat slip.
No other medication requests will be processed. If you have been requested to attend the surgery for a review and not done so we will not be able to process this request. 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.

Request 1*

Request 2

Request 3

Request 4

Request 5

Request 6

If you require more than 6 items please submit another form for the remaining items.

Please identify your preferred collection point:*

Privacy

About Your Privacy

We take great care to safeguard personal data provided by patients and process such data fairly and lawfully in accordance with the Data Protection Act 1998.

We do not capture and store any personal information about individuals who access this web site, except where you voluntarily choose to give us your personal details via email.

In these latter cases, the personal information you give us is used exclusively by Bideford Medical Centre as part of one of our on-line services e.g. Repeat Prescription Requests.

We do not pass any of your personal information to outside organisations and/or individuals.

I confirm that I have read the privacy statement.*