Contact Number:

Date of Birth:


Britannia Branch ( 1st line address of branch ) :



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By submitting this form I give consent for Britannia pharmacy to order my prescription from my surgery.

 

Repeat Prescription Service Order or Query
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Please ensure that you provide full details, and allow sufficient time to order your prescription. Your prescription will be ready for collection from your local branch within 48-72 hours.

Please note; On occasions your prescription may take longer than 72 hours based on individual circumstance

 

*Please complete all fields, If you experience any technical problems, please send a email to CustomerService@britanniapharmacy.com