Prescriptions

Repeat Medication Request Form

Please allow 4 full working days for your prescription to be processed by your GP and Pharmacy. Order in advance to avoid delays.

First Name*

Last Name*

Phone Number*

Date of Birth*

Address*

Postcode*

Repeat Medication Details

Drug NameStrengthQuantity

Additional drugs/information

Select Your GP Surgery*

Bruntsfield Pharmacy Instructions

How would you like to receive your medication?*

Collect from Bruntsfield PharmacyDeliver to my home

Note: Both collection and home delivery are completely free of charge.

Confirmation & Notifications

Opt-in for text updates about my prescription status.I declare that the information I have provided is accurate and complete.*