Repeat Prescriptions

We have arrangement with all local surgeries to dispense repeat prescriptions to patients -

This service is only available to patients of these surgeries who have a valid, up-to-date, repeat prescription.

Please Note: We are also able to accept prescriptions electronically using the secure NHS Electronic Transmission of Prescriptions Programme (ETP); ask us for details or click here to download the nomination form.

First Name

Surname

Date of Birth

Address

Postcode

Telephone Number

Please select your surgery

If your surgery is not in the list above please provide your surgery details here:

Drug Name & Strength

If you require more than 8 items, please submit another request.

Comments (any comments that you may have about this service)

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.

I consent to my information being used for the purposes described above and wish to submit this online form to Shirley Pharmacy • 175 Shirley Road, Croydon, CR0 8SS.

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.

Submit Form

Key Information

Repeat Prescriptions

Privacy Protection