Bellingham Green Surgery - Online Services
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Patient Details
Special instructrions

Form instructions


How do I complete this form?

Enter your personal details, collection point info, your repeat requests and any special instructions into the fields. The [tab] key can be used to move between fields. When you have finished, press the ´Request Prescription´ button to move to the confirmation page.


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.


What can I use the Special Instructions for?

If you have any instructions for us regarding your order, please tell us. However, this box should not be used for medical enquiries regarding your prescription.


I have more than eight drug requests. How do I submit the extra requests?

If you have more than eight drug requests, please submit the first batch. Then, re-use the form to submit the remaining drug requests.


Other Notes:

All fields marked with * are mandatory. Your Drug Names and Doses can all be found on your repeat prescription request slip.


Prescription Collection:

Collection from Surgery: Allow at least 48 working hours for us to process your request.

Collection from Pharmacy: Processing time may be longer than 48 working hours as it is dependent on the pharmacy.

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