Request repeat prescription

Repeat prescriptions can be ordered by phone through the 'repeat prescription number', getting in contact with our assistant or by using this repeat prescription form.

To be able to use this form you must be registered at our practice and the medication you order must already been prescripted to you by your general practicioner or other medical specialist.

After submitting the form you will receive a confirmation email at the address given in the form.
When we have received your request on a working day before 10:00 and without further notice from us, your prescription will be available the next working day after 14:00 at your pharmacy.

Repeat prescription form

1
Repeat medication
2
Your data (1)
3
Your data (2)
4
Confirm

Fill in the information concerning the repeat medication.

Medicatie

	Naam	sterkte	Aantal	Dosering	Weight
	Naam	sterkte	Aantal	Dosering	Item weight

more items

Gebruik + om een regel toe te voegen.
Gebruik x om een regel te verwijderen.