ONLINE PRESCRIPTIONS

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ONLINE PRESCRIPTIONS
   
 

 

PLEASE COMPLETE THE FORM BELOW

 
   
 

Prince of Wales Road Surgery
87-89 Prince of Wales Road
Kentish Town
London
NW5 3NT
Tel: 020 7284 3888
Fax: 020 7267 6067

Email us

Dr Philip Matthewman
MB Ch.B Bristol 1979, FRCS 1984, FP Cert

Receptionists:
Laura & Fiona

 

These should be requested in writing whenever possible. This is to avoid errors and keep telephone lines free. While-U-Wait repeats done whenever possible and within 24 hours maximum. You may also request repeats by using the form below:

You must complete all boxes marked with an *

Please ensure you enter the correct name and dosage of the medication you require - refer to your previous prescription repeat slip for details.
(NB: if you do not have a repeat slip, you cannot order online)

Patient Number *

This is the number on the top right hand
side of your repeat prescription

First Name *

Surname *

Date of birth *

Contact e-mail

Telephone number

Address *

Prescription Details

   
Description Dosage
01*
01
 
 
 
 
02
02
 
 
03
03
 
 
04
04
 
 
05
05
       
       

THANK YOU FOR YOUR REQUEST

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Last updated June 2008
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