Repeat Prescription Request Form

Please allow at least 24 hours for the item to be ready for collection. You will be contacted when your medicines are ready.
Medicines cannot normally be returned.
By requesting a repeat prescription, you accept the price charged by the Practice. Where It is not collected you may still be charged the full price.
Prescription Only Medicines can only be provided to clients of the Practice unless you have an actual written Prescription; the original will need to be presented to the Practice before the item is dispensed.

20%

Personal Details
Title*
Name*
First Last
Address*
Street Address Address Line 2 City County Post Code
Phone / Mobile*
Email*
In your knowledge, have we given your pet a health check within the last 3 months?*

Keeping in Touch
Yes please, I would like to receive reminders (i.e. appointments, boosters and treatment reminders)
- By email
- By phone (including text message)
- By post
Yes please, I would like to receive marketing communications (i.e. products and services)
- By email
- By phone (including text message)
- By post
Terms & Privacy
*
- I agree
I agree to have read and accepted your Terms of Business and Privicy Notice. Your privacy is important to us and you can find out more about how we use your data from our “Full Privacy Notice” which is available from in the links above.
*
- i am over 18

Personal Details