Martin Davies Chemists Ltd - Newport, Gwent

Repeat Prescriptions

Repeat Prescription Form

Full Name

Date of Birth (dd/mm/yyyy)

Address

Telephone Number

Email Address

Your Surgery

Your Medications

Please tell us what medication you require. Be specific and check your spelling.

Please take all details from your repeat prescription record slip.

Please note that the first medication field and its corresponding strenght field are required for this form to be submitted.

If you require more than 8 items, please submit another request.

CONFIDENTIALITY - TERMS AND CONDITIONS

The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The Pharmacy accepts no responsibility for breaches in transmissions.

By completing this form, you are agreeing for us to contact you. Any personal details supplied will be used and stored in connection with this enquiry.

Details entered will be sent by email. If you do not wish to send your details by email, you can also contact us by telephone.

I accept the terms and conditions above and understand that by ticking this box I give my consent for Martin Davies Chemists Ltd to order, pick up and dispense this repeat prescription.

To help prevent spam, please answer the following question:

We have an arrangement with the following surgeries to dispense repeat prescriptions to patients -

Beechwood Surgery
373 Chepstow Road – Tel: 01633 277771

Isca Medical Centre
Cadoc House, High Street, Caerleon – Tel: 01633 423886

Lliswerry Medical Centre
Fallowfield ive, Newport - Tel:01633 277333

Malpas Brook Health Centre
107 Malpas Road – Tel: 01633 855808

Park Surgery
375 Chepstow Road – Tel: 01633 277442

Richmond Clinic
172 Caerleon Rd, Newport – Tel: 01633 259970

Ringland Medical Practice
Ringland Circle, Newport – Tel: 01633 277011

Rugby Surgery
5 Kelvedon Street, Newport – Tel: 01633 258545

St Davids Clinic
Belle Vue Terrace, Newport – Tel: 01633 251133

St Julian's Medical Centre
13a Stafford Rd, Newport – Tel: 01633 251304

St Pauls Clinic
Palmyra Place, Newport – Tel: 01633 266140

Westfield Medical Centre
34 Westfield Ave, Malpas, Newport – Tel: 01633 855521

This service is only available to patients of these surgeries who have a valid, up-to-date, repeat prescription.

Please allow your surgery up to 4 working days before collection.