Tablets

Repeat Prescription Order

PLEASE COMPLETE THE FORM BELOW

Is it difficult for you to get your prescription from the surgery? Are you busy at work or perhaps unsteady on your feet. Let us order, collect and deliver the prescription for you. Ring us or use our E-mail address to arrange for us to help. We can arrange to collect your prescription from the surgeries in Peterborough.

If you have any questions about any of our services or wish to find out further information on any one of our services please either call us on 01733 253433 or send an E-mail on the contacts page.

* Please ensure the form is fully completed otherwise your repeat prescription may be delayed or we may not be able to fill your order.

Your Name :
Date of Birth (DD/MM/YYYY) :
Your Address :
Your Postcode:
Telephone Number:
Surgery Address :
Name(s) of Medication :
Please choose 1 : Delivery required
Patient to collect from Pharmacy

I authorise The Chemist Shop of Peterborough to receive my repeat prescriptions from the sugery or by electronic transfer. I wil notify The Chemist Shop of Peterborough if I wish to change or amend this arrangement.