Repeat Prescription Service

Chemist Counter Direct can dispense both NHS Prescriptions and Private Prescriptions from any UK registered GP. To use either service the form below must be completed, to enable us to either request or dispense your prescription.

If your prescription is required urgently please call our pharmacist on 01270 768691.

All repeat prescriptions will be dispensed using the Electronic Prescription Service. All repeat prescriptions will be ordered by Chemist Counter Direct and delivered to the address provided by you on the form below. We would aim to deliver your prescription within 4 business days from ordering - our pharmacist will stay in contact with you throughout the process using your preferred method: telephone, text message or email.

We are a fully UK registered pharmacy, our registration details are below:

Chemist Counter Direct Ltd registration number: 1112267
Paul Reel is a registered pharmacist.
General Pharmaceutical Council Number: 2037791

Patient Details

First Name

Surname

House Number / Street

Town

Postcode

Email Address

Mobile Phone Number

We will use this number to send text message delivery alerts

Phone No.

At least one number is required should we need to talk to you. We will not share your telephone number with others.

NHS Number

Your NHS Number can be found on your Prescription.

Date of Birth

YYYY

Doctor's Details

Name

Surgery / Address

Postcode

Declaration

I am the

Patient

Carer of the Patient

Carer First Name

Carer Surname

Tick this box to confirm you authorise Chemist Counter Direct to request/collect/dispense your repeat prescription(s) either electronically (EPS) or a paper prescription (FP10).

Yes, I confirm

Tick this box to confirm you agree to the Terms and Conditions.

Yes, I Agree

Do you have an exemption for prescription payments, if so, what is it?

Your Signature

Type the name of the person filling this form, this constitutes your signature