Order your Repeat Prescriptions – Dalkeith Road Medical Practice

Request a Prescription

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

How do you wish to request your prescription?*

Please note, patient services is for registered patients only. If you wish to sign up for patient services, please contact the surgery.

Please follow the below link to access Patient Services (Registered through Surgery)

Order prescriptions through Patient Services. Please note, this is for patients who have signed up through the surgery only

Order prescriptions online (manually)

Personal Details*

Prefix

First Name*

Surname*

Date of birth*

House/Flat Number

Address Line 1*

Address Line 2

City*

Postcode*

Telephone*

Email*

Your doctor

Prescription request

Please use the below fields to request your prescriptions.

Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending

Prescription item 1

Prescription name

Strength

Quantity

Prescription item 2

Prescription name

Strength

Quantity

Prescription item 3

Prescription name

Strength

Quantity

Prescription item 4

Prescription name

Strength

Quantity

Prescription item 5

Prescription name

Strength

Quantity

Prescription item 6

Prescription name

Strength

Quantity

Prescription item 7

Prescription name

Strength

Quantity

Prescription item 8

Prescription name

Strength

Quantity

Prescription item 9

Prescription name

Strength

Quantity

Prescription item 10

Prescription name

Strength

Quantity

Comments or Additional Info

Please DO NOT include medical problems here - these should be discussed with your doctor.

Request a Prescription

Please follow the below link to access Patient Services (Registered through Surgery)

Order prescriptions online (manually)

Prescription request

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