Studholme Medical Centre
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Online prescriptions
Online Prescription Security.  This form is sent to us 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 *   * You must provide this information.  
  Date of Birth *    
  Contact Telephone *  

 
  PIN number

 

    
  Address      
  Comments      
  Select how you will collect your prescription

 
 		    
  If you have selected 'Other' please give details here>>>          
               
  Item   Strength   Amount    
  e.g. Paracetamol   e.g. 500mg   e.g. 100 tablets    
   

     
         
         
         
         
         
         
         
         
         
               

                                 

 
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