Repeat prescription registration form

Save time money & paper by using our safe & secure

NHS Electronic Prescription Service

Get your prescriptions sent to SHIRLEY PHARMACY without the need for posting or collecting from the surgery. Instead of your GP giving you a prescription on paper, they will electronically send it straight here as part of the NHS Electronic Prescription Service. We want to make it as easy as possible for you to get your prescription and we are offering this free and convenient NHS service. It will save the surgery time too.                            

You can either complete the form online below or click here to download the form.  Return the completed form to the pharmacy.

Repeat prescription registration form

Name and address of nominated dispenser:


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.