Request a Repeat Prescription Online

Contact Us

St Mary’s Surgery
St. Mary’s Close
Timsbury
Bath
BA2 0HX

Telephone
01761 470880

Fax
01761 472492

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. If you have an issue with this please feel free to use our normal repeat prescription service.
Patients Name *
Date of Birth *
Address
Contact Tel.*
Email Address
* You must provide this information. The items requested below MUST be on your regular repeat medication list.
	Item Description	Dose	Quantity
	(e.g. Paracetamol)	(e.g. 500mg)	(e.g. 100)

Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
	* Not for medical problems *
Comments about this Prescription