Abbey Surgery, 28 Plymouth Road, Tavistock, Devon PL19 8BU

Abbey Surgery, 28 Plymouth Road, Tavistock PL19 8BU, Tel 01822 612247 Fax 01822 618771 Email abbeysurgery@nhs.net

REPEAT PRESCRIPTION FORM

Before using this form please read the notes HERE. Please make sure you complete the form accurately. Fields marked * are compulsory. Click the Order Repeat Prescription button at the bottom of the form when you have completed it.

*Patient Number:
*Date of Birth:
Day:		Month:	Year:
Repeat Prescription Items:
	Description		Quantity
*1:
2:
3:
4:
5:
6:
7:
8:
*I have read the Repeat Prescription notes (type YES):

You will be able to collect your medication from your usual collection point.

The information you have entered is sent via the Internet to Abbey Surgery, and may not be secure. However your Patient Number is known only to the Surgery and yourself and cannot be used to trace you.

Abbey Surgery, 28 Plymouth Road, Tavistock, Devon PL19 8BU Tel: 01822 612247

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