Repeat prescription order

  • Please provide as much information as possible on the form. The form cannot be submitted without the mandatory information marked with an asterisk (*).
  • Please enter your full name
  • Please enter the first line of your address or the name of the building you live in.
  • Please enter the second line of your address
  • Please enter the name of your closest town or city
  • Please include all dosage information. Please note that the prescription charge is £20.
  • By submitting this form you agree to Dr Susan Horsewood-Lee saving your personal information for the purposes of dealing with your request or enquiry. You can read our Data protection policy here.