Repeat Prescription Request - Pontardawe Primary Care Centre

Please make your repeat medication requests by completing the form below or by using My Health Online.

We would advise that you order any repeat medication 7 days before it is due. This will allow the surgery time to process the prescription and for the pharmacy to prepare and dispense it.

Wherever possible we will send it to your local designated pharmacy. If you do not have a designated pharmacy and would like your prescription to be sent to them please let us know who is your chosen pharmacy is when you make your request.

About the patient

Is this request submitted for yourself or for someone you care for? Please note the practice must have received written consent to discuss any patient medical needs who are over the age of 18+

On behalf of myself
On behalf of my child
On behalf of someone I care for and confirm the practice already has written consent for this.

Name of patient

Date of Birth

Your preferred contact number

Email address

Medication Required

Preferred Collection Point

Please list all medications required to include Name, Strength / Dosage and quantity required. You can request up to 10 items using this form. Please list individual items below

Item 1 - Medication Name, Strength / Dosage, Quantity

Item 2 - Medication Name, Strength / Dosage, Quantity

Item 3 - Medication Name, Strength / Dosage, Quantity

Item 4 - Medication Name, Strength / Dosage, Quantity

Item 5 - Medication Name, Strength / Dosage, Quantity

Item 6 - Medication Name, Strength / Dosage, Quantity

Item 7 - Medication Name, Strength / Dosage, Quantity

Item 8 - Medication Name, Strength / Dosage, Quantity

Item 9 - Medication Name, Strength / Dosage, Quantity

Item 10 - Medication Name, Strength / Dosage, Quantity

If you would like to upload an image of your current repeat medication list, please do so here