Repeat Prescriptions

Grange Medical Group Repeat Prescription Form

Please Complete Your Details

Please note that Repeat Prescriptions can also be ordered in person, by post or through the Chemist.

Fields marked with an * are required.

Firstname*: Lastname*:

Telephone*: Date of Birth*:


Please Enter Your Item - Descriptions, Strengths And Amounts Below

1.Description*: 1.Strength*: 1.Amount*:

2.Description: 2.Strength: 2.Amount:

3.Description: 3.Strength: 3.Amount:

4.Description: 4.Strength: 4.Amount:

5.Description: 5.Strength: 5.Amount:

6.Description: 6.Strength: 6.Amount:

7.Description: 7.Strength: 7.Amount:

8.Description: 8.Strength: 8.Amount:

9.Description: 9.Strength: 9.Amount:

Any Other Information

This verification is to prevent abuse of this system. The 'Submit to Surgery' will be greyed out and disabled until you enter the correct answer and click HERE


Grange Medical Group