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


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