Drs John Coffin and David Acorn
0844 477 3088

Repeat Prescriptions Online

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If you would like to order your repeat prescriptions online, please complete this form. We will normally supply enough medication for a month. Please note that requests must be sent before 10 a.m. in order to be processed within two working days (Monday to Friday).
Warning! Use the TAB KEY to move your cursor from one box to another, pressing RETURN will submit your request
Enter your Name
	Name
Enter your date of birth ( dd/month/yyyy )
Day		Month		Year

Your daytime phone number, in case we need to contact you (optional)
Phone number

Enter the medication you would like (if you need more than 8 items send a second order)
1	Name		Strength
2	Name		Strength
3	Name		Strength
4	Name		Strength
5	Name		Strength
6	Name		Strength
7	Name		Strength
8	Name		Strength
If you need more than 8 items please submit a second form. You can enter any other comments about your medication request in this box, but don't use this to ask for general enquiries or medical advice. Instead, for medical advice always phone us on 0844 477 3088

When you press the submit button, information about you will be sent across the internet. It is not encrypted, but will be no less secure than a normal e-mail.

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