• Millhouse Medical Centre
  • Millhouse Medical Centre
  • Millhouse Medical Centre
  • Millhouse Medical Centre
  • Millhouse Medical Centre
  • Millhouse Medical Centre
Millhouse Medical Centre Prescription Request Form

Have you seen a doctor or visited the hospital recently? Yes No

First Name
Surname
Address
Phone *
Email *

Doctor Name

Due to Covid19 we will fax your script to a pharmacy of your cholce - please do not come into the clinic to collect your prescription.

Yes
Enter pharmacy details below 

Pharmacy Name
Pharmacy Address

 Fax Number

This service is provided for our registered patients. 24 hours notice is required for repeat prescriptions; after this time prescription may be collected  from the pharmacy.  A nurse or doctor will phone if there are any problems with this request. Please Note that all patients requesting medication must be seen in person at LEAST once a year.

Please list
            medications

Don't Forget to press SUBMIT

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