Copy of Under 16s Order Repeat Prescr...

Under 16's Only - Order Repeat Prescriptions

Complete and submit the form below to order your prescription.

Please note this service is not available for over 16's.

Patients aged 16 or over are encouraged to sign up to EMIS Patient Access, click here for details, or request their Pharmacist take over their repeat prescription request.

Your Medication Request

Please tick this box before submission to acknowledge that this form is being sent un encrypted via the world wide web

I confirm I am under 16 or acting on behalf of my child.

The information you have completed in this form will be stored in the Wix Website Editing Software, which is accessed using the practice's Wix login via the world wide web, please tick this box to confirm you are happy for this information to be stored.

If you are not happy to tick the boxes above please write down your details as requested above and return it to the surgery.

Thanks for submitting. Please allow 48 hours for prescriptions requests.

Waterside Health Centre

The Red and Green Practice

Waterside (Hythe) and Blackfield Health Centres

Southampton

Partners in the Primary Care Network (PCN)

Blackfield Health Centre