Convenient online form for submitting repeat prescription details
⚠️ This service is not affiliated with the NHS — it is hosted by GDS
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No personal data is stored or transmitted; all information stays in your browser.
Patient Information
Please complete all fields below. Once you generate the email, your formatted message will appear beneath the form ready for you to copy and send manually.
Your Email Message
📋 Copy and paste the following message into your email:
