Online Repeat Prescriptions

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Manor Way Surgery
Manor Way
Lee-on-Solent
Hants
PO13 9JG

Tel: 02392 553161
Fax: 02392 554135
Out of Hours:
02392 377921

This service is only for medications which have been authorised to be issued as repeat prescriptions. Medications not on your list of repeat medications will not be issued.

Please Note: This form is sent to us via computers that do not belong to the NHS in a non-encrypted format. Complete confidentiality for this type of repeat prescription request can not be guaranteed.

Patients Name*
Date of Birth*
Address
Contact Tel.*
Email Address

*You must provide this information

	Item Description (e.g. Paracetamol)	Dose (e.g. 500mg)	Quantity (e.g. 100)
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8

	Comments regarding this prescription. (NOT for medical problems)