To Order your repeat prescription please fill out the form below.

    Patient Name

    Patient Date Of Birth

    Please note that dates MUST be in the format of DD/MM/YYYY ie: 21/02/1950.

    Daytime Contact Number

    Patient Post Code

    Email Address

    Collection Location

    Patients should be advised that all prescriptions will be sent to Eyemouth Pharmacy unless an alternative option is selected below.

    *Collect paper prescription in person from Eyemouth Health Centre option should be selected for use of any other community pharmacy.

    Prescription Required:

    Please be sure to include your prescription strength and quantity, For example: Paracetamol, 500g 1 Pack.

    Please use an individual line per drug required.

    Drug Name Drug Quantity Drug Dosage

    Check this box for antispam