Repeat Prescription Request Form for Llanharan patients only

Please complete parts 1, 2, 3 and 4. Your e-mail request will not be processed unless each section is completed in full. You may return to the main prescription page by using the Back button in your browser. Please read the important notice at the bottom of this page before sending your request.

Part 1    Patient Details (must be completed in full each time). If details provided are incorrect, your order will not be processed by our staff.

 

Contact Details

 The NHS number is the 10 digit number below your address on your repeat side slip. Please enter all 10 digits without any spaces. See "How do I" section for explanation of side slip
We are no longer using ID codes
NEW** Patient's NHS NUMBER  
Your e-mail address  
Patient's surname  

Part 2    Repeat items requested. Note: Only items listed on your repeat prescription side slip can be ordered and they can only be ordered when they are due

Drug name and dose

 You may add up to 10 items in this section. Please type only one item in each box. If you require more than 10 items, send the first 10 then complete another request for remaining items. Only items listed on your repeat slip can be ordered and they can only be ordered when they are due.

Please type in the medication names with the exact spelling and doses as shown on your repeat prescription slip (the name shown on the tablet box may be a different "brand name" - it's the name on the repeat slip that we need).

Any requests for items not listed on repeat will NOT be processed
 

Part 3    What to do with your completed prescription

Please select one option
 

 
Part 4    Finally, click the button below to send your request to us:

Please allow 2 working days to process your request. Requests are not processed on Saturday or Sunday.

Copyright © 2007Pencoed Medical Centre. Designed by Dr G A Preest.  All rights reserved. Revised: 19-12-2007
Important Notice - PLEASE READ BEFORE SUBMITTING YOUR REQUEST
We have designed this form so that the information given could not easily identify a patient to others. Although this form is e-mailed directly to Pencoed Medical Centre, please bear in mind that it is possible for e-mail in general to be intercepted and read by third parties. Your e-mail may be seen by non-medical staff and we cannot guarantee the confidentiality of the information submitted to us by e-mail. We cannot accept responsibility for any typing errors. It is your responsibility to decide whether to act upon the information given at this web site. This facility is intended ONLY for patients living within our practice area and registered with us. If you do not live within our practice area and are not registered with us, please do not proceed further. The authors of this website will not accept responsibility for any consequences arising from the advice given within this website. This website does not contain any confidential material, patient details or clinical records. It is not possible to access confidential information, patient details or clinical records via this web site. Please do not send any confidential or private information to us via this web site or via the Internet. The hardware used to maintain this site is totally separate and not connected in any way to our clinical systems. The information contained on this site is general information which is not in any way intended to replace the specific advice that patients may obtain from their own doctor about individual care. Please do not send any personal medical questions for Doctors by e-mail.