Repeat Prescription Request Form

Repeat Prescription Request Form

If you are not registered for online services (NHS Wales App), you can use this form to request any repeat prescriptions from the Practice. Please allow 3 working days before collecting your prescription. In future you may wish to consider registering for our Online Services. The Online Services system remembers which medications you are on and makes requesting repeat prescriptions faster and easier.

  • Your Details

    Date of Birth
    For example, 15 3 1984
    I consent to text messages from the practice (appointment reminders, invites, etc) (optional)

  • Medication Required

    Collection Details (optional)
    This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. (optional)
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Page last reviewed: 29 September 2025
Page created: 19 September 2025