Medication Synchronisation Request

If you would like to save time and order all the medication you have on repeat at the same time rather than irregular times throughout the month please use the form below.

When you next need to request an item on repeat count up all the tablets you have and fill in the form. Your doctor will issue a “one off” prescription of the tablets you need to synchronise all your medication to within a day or two.

Full Name

First Last

Date of Birth

Phone Optional

Named GP (if known)

Where do you collect your prescription from?

Please list each of your medications, their strength i.e. 50mg and how many of each item you have left.

Declaration

I confirm that my enquiry is not urgent, and it may take up to 2 working days before I receive a reply.