Repeat Prescription Request

If you do not have a NHS Wales App account, you can use this form to request any repeat prescriptions from the Practice.

Please allow 72 hours (3 working days) before collecting your prescription.

In future you may wish to consider registering for NHS WALES APP/Ap GIG Cymru.

Required field(s) are indicated by *
Repeat Prescription Request

Repeat Prescription Request

About you

As it appears on your passport.

As it appears on your passport.

The one used to register with your GP.

Your date of birth is required to verify your identity.

As on your medical record.
This phone number will be used for all correspondence relating to this request.

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Please continue completing the form below

Medication Required

Item Description
Strength
Quantity