Your name:

Your email address:

Your Ellesmere Medical Practice computer REF number:

(your REF number is on the top left hand corner of the green repeat prescription request slip)

Where you would like to collect your prescription from? (you may pick up your prescription directly from Rowlands in Ellesmere if you wish)
Collect from surgery Rowlands Ellesmere

The repeat prescription items you need: please include the drug name and the dose eg: Aspirin 75mg

When you are sure that you have completed this accurately, this information to the Ellesmere Medical Practice prescriptions desk.

Please wait for the confirmation screen.

this form and start again