Sturry Surgery & Canterbury Health Centre

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Repeat Prescription
Form

Use this form to order your Repeat Prescriptions on-line. Please complete all fields and then click the Submit button to send the form to us.

Please note: you will be sent a confirmation email with a unique reference code for your use. Please allow 1 hour for the confirmation email to arrive. If no email has been received after 1 hour you should assume that an error has taken place and either call in on the phone or resubmit the prescription.

Surname: *

First Name: *

Date of Birth: *

First Line of Address: *

Home Phone Number: *
Email Address: *

Items needed: * (Please copy names and doses)

Usual Surgery: *

Chemist/Collect: *


	[ Different Image ]
Please enter the security code you see above (if the letters and numbers are unclear click on the ‘Different Image’ link for a new code) *





Please allow 48 hours for this request to be processed

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