BMC - Repeat Prescription Requests

If you’re unable to request medication via the NHS app or have a question about your prescription, please fill out this form. Allow up to three working days before collecting your prescription. We’ll reach out if we need any additional information.

Last Updated: 02/11/2024

Your Details

Name *

Date of Birth *

Phone Number *

Email Address *

Medication Required

What medication do you require? *

Additional Comments

Collection Details *

I have a nominated pharmacy and will arrange my collection from the pharmacy.

I don't have a nominated pharmacy, but I've provided the details of the pharmacy I'd like to collect from in the additional comments section above.

This form collects your name, date of birth, email, and other personal and medical information. We use this information to verify your registration with the practice, enable our team to contact you, and update your medical records held by the practice and our NHS partners. Please review our Privacy Policy to learn how we protect and manage your data. *

I consent to the practice collecting and storing my data from this form.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Bancroft Medical Centre website

BMC - Repeat Prescription Requests

Further Information

Connect With Us