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.

If you are human, leave this field blank.

About You

First Names *

Last Name *

Date of Birth *

Please use the format: DD/MM/YYYY.

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)