Prescriptions

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Use the form below to submit a prescription request.

For more information about setting up this service click here. If you still have questions don’t hesitate to contact us.

    Personal details

    Address

    Surgery details

    Prescription details

    Please write down the Name, Strength, Form and Quantity of each medicine you require e.g. Atenelol Tablets 25mg x 28. Only order what you need.

    I understand that by signing below I give permission for my prescriptions and information about my repeat medicines to be sent electronically to AR Pharmacy Lyndhurst and my GP.

    Please sign here