Repeat Prescriptions

To request a repeat prescription, please enter your personal details below, followed by the name, strength and quantity of medication you require. Please allow at least 48 hours before visiting your collection point.

We can only process requests for repeat prescriptions – if you require a new medication you will need to book an appointment or speak to one of our doctors on the telephone.

Full Name

Date of Birth

Telephone

Your GP

Preferred Collection Point

Medication Required

Medication 1

Drug name

Strength

Quantity

Medication 2

Drug Name

Strength

Quantity

Medication 3

Drug Name

Strength

Quantity

Medication 4

Drug Name

Strength

Quantity

Medication 5

Drug Name

Strength

Quantity

Medication 6

Drug Name

Strength

Quantity

Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending

CommentsPlease do not include any medical questions or problems here. Any medical question/problem should be discussed with a medical practitioner.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Knock Medical Centre • 423B Upper Newtownards Road, Belfast, BT4 3LH.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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