Gade Surgery: Gade House, tel 01923 775291, Witton House, tel 01923 283900


GADE SURGERY REPEAT PRESCRIPTION FORM

This service is likely to be discontinued in 2016 and will replaced by our on-line ordering service

This form is to request your normal medication. The request will take 3 working days and will then be available for collection by you or your representative or delivered electronically to your nominated pharmacy.

A new way of issuing repeat prescriptions called 'repeat dispensing' has largely superceded postdated repeats. Please go to the news page for further information.

For submission of repeat prescription requests, you may copy and paste the form below into an email, fill it in and email it to gade.prescriptions1@nhs.net

When ordering your repeat prescription, preferably use your GPís online ordering system or use the most recent repeat prescription request form. It is intended to phase out email ordering of repeat medicaton. Check the medicines you already have at home before you order so that you only order the medicines you need. It is important not to stockpile medicines at home. If you are using a repeat prescription request form then cross out the medicines that you donít need (you will still be able to order them in the future) and record the number of items ordered. Remember to sign the form. If you are picking up medicines from your pharmacy and you realise that you have ordered items that you donít really need then give these back to the pharmacy prior to leaving. Your prescription can be adjusted accordingly. Let your GP or pharmacist know if you have stopped taking any medicines. Make an appointment with your GP for a medicines review on a regular basis Ordering medicines over the phone can lead to mistakes so please order them on line or in person. If this is difficult for you please ask your GP for advice

Please provide all the information requested.


Patient Name:
Address line 1:
Address Line 2:
Date of Birth:
Home Telephone:
Email Address:
NHS no. if known:

DRUG/ITEMS REQUESTED with dose and number of months
Item 1:
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Item 9:

Please specify if to be collected from Rickmansworth or Chorleywood and if to be collected by a chemist or sent electronically to your nominated chemist

Email to gade.prescriptions1@nhs.net


PLEASE NOTE THAT NO CONFIRMATION OF RECEIPT OF YOUR REQUEST WILL BE SENT. ALSO PLEASE NOTE THAT THIS MESSAGE IS NOT ENCRYPTED AND SHOULD NOT BE USED TO CORRESPOND WITH YOUR DOCTOR.
 
 
 
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