The Farmhouse Surgery - Online Services
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This form is to be used for contacting the practice for comments and suggestions only. 
This form is not to be used for repeat prescription requests or for any clinical questions related to your health as it is not constantly monitored.

Any patient requiring a password to order online repeat medication please telephone the prescription line 488486 and ask the receptionist if they could print off a password for you.  This will be ready for collection by the next day.

Contact form

Form instructions


How do I complete this form?

Simply enter your personal details into the fields so that we can identify you – these are mandatory. Then complete the rest of the form. You can use the [tab] key to move between fields. When finished, press the ´Send Message´ button at the bottom of the form.


Are my details secure?

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible.

We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. When you submit your information, it is safely transmitted over the web in an encrypted form and deciphered using the private key at its intended location.


Other Notes:

All fields marked with * are mandatory.

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