Porlock Medical Centre

Repeat Prescriptions

To order a repeat prescription on-line, please complete the form below and click on Submit.

Your Details
Name:
Email:
Date of birth:
Work Tel.
Home Tel.
Fax No.
Prescription Details
Quantity Strength Description
Request 1:
Request 2:
Request 3:
Request 4:
Additional Information
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What is two plus three?