August 19, 2010 11:52	Tel: 01928 566561 \| Fax: 01928 590212

Grove House Practice
St Pauls Health Centre, High St, Runcorn,
Cheshire WA7 1AB

online Repeat prescriptions

Registered patients can use this form to order repeat prescriptions. You may only order medication that is already on our computerised repeat prescription record. Please allow at least 2 working days (48 hours) for your request to be processed.

Should you need to order more than fifteen items, please submit the first fifteen then return to the form to make another request. Do not use this service for items you require urgently.

According to medical guidelines and good practice we can only supply 28 days of most medications at one time to our patients. This is endorsed by our PCT.

To help ensure high standards we would prefer to deal with comments or queries regarding medication by telephone on 01928 566561, between the hours of 8.30am – 5.30pm, Monday to Friday.

Please fill in the form below and use the 'submit' button to send your repeat prescription request to us. ALL FIELDS MARKED WITH AN ASTERISK ARE REQUIRED.
Full Name:*
Address:*
Post Code:*
Date of Birth (dd mm yyyy):* (eg: 20 - 02 - 1971)
Home Telephone:*
Computer Number:
Requested by:
Email Address:*
Confirm Email Address:*

	Medication Name	Strength	Dosage
Prescription Request 1:
Prescription Request 2:
Prescription Request 3:
Prescription Request 4:
Prescription Request 5:
Prescription Request 6:
Prescription Request 7:
Prescription Request 8:
Prescription Request 9:
Prescription Request 10:
Prescription Request 11:
Prescription Request 12:
Prescription Request 13:
Prescription Request 14:
Prescription Request 15:
Prescription Request 16:
Prescription Request 17:
Prescription Request 18:
Prescription Request 19:
Prescription Request 20:

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