Only existing patients of DoctorNow can request repeat prescriptions by completing the form below. Fields marked with an * are required.
Title
Last Name*
First Name*
Date of birth*
Address*
Phone*
Email*
Name Of medication required*
Strength (e.g. 10mg)*
Quantity (e.g. 28 tablets)*
Dosage (e.g. one tablet per day)*
RemoveAdd another medication
How would you like to be informed when your prescription is ready?* —Please choose an option—SMSEMAILTelephone
When ideally is the prescription required by?*
How would you like to receive your prescription?* —Please choose an option—Collect from the practiceFax to PharmacyPost to home addressTotally Pharmacy
Please provide any further information
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