St Peters Surgery
Broadstairs

Tel: 01843 608860
 
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  Order a Repeat Prescription Via Our Online Form


We are now offering a NEW online service for ordering repeat prescriptions. THEREFORE PLEASE NOTE THAT THIS FORM WILL BE REMOVED END OF MARCH/START OF APRIL. If you wish to continue to order repeat prescriptions online please sign up to our new system. Read how to do this here
 

Disclaimer: This form is sent to us via computers that do not belong to the NHS in a non-encrypted format. Complete confidentiality for this type of repeat prescription request can not be guaranteed. If you have an issue with this please feel free to use our normal repeat prescription service.

 
Patients Name *  
Date of Birth *    
Address    
Contact Tel.*    
Email Address    
Collection  
* You must provide this information.
The items requested below MUST be on your regular repeat medication list.
   
 

     Item Description

Dose

 Quantity
       (e.g. Paracetamol) (e.g. 500mg) (e.g. 100)
       
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
       

* Please type in the green word in lower case into the box below (in order to help us reduce spam email)

 

   
   
* Not for medical problems *
   
Comments about this Prescription

 

                          

 
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