Repeat Prescription Request Form

If you do not have a full Patient Access account, you can use the form below to request any repeat prescriptions from the Red House Group.

Please allow 5 working days before collecting your prescription. To find out more about repeat prescriptions please see the Prescriptions area of our website.

Note: a calendar should appear to enable you to enter your date of birth.  If it does not, please enter the date in the form yyyy-mm-dd (for example 1973-04-25).

If you are human, leave this field blank.

About You

First Names *

Last Name *

Date of Birth (YYYY-MM-DD) *

Address *

Home Telephone

Mobile Telephone

Email Address

Medication Required

If you are requesting Warfarin please enter the following information:

Last INR result:

Date of Test

Item Description

Strength

Quantity

1

Dose

Quantity

2

Item 2: Dose

Item 2: Quantity

3

Item 3: Dose

Item 3: Quantity

4

Item 4: Dose

Item 4: Quantity

5

Item 5: Dose

Item 5: Quantity

Additional Comments:

Where would you like to collect the prescription from? * Please Choose... Red House Surgery Gateways Surgery Park Street Surgery Manor Pharmacy (Radlett) Boots Pharmacy (Radlett) Crown Pharmacy (Shenley) How Wood Pharmacy Other (please specify in comments above)