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.

Prescription Synchronisation

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Named GP (if known)

Where do you collect your prescription from?

How many prescriptions do you need to synchronise and what are they for?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

Medication synchronisation request

Privacy Policy

Health A-Z

Live Well

Medicines Guide

Care & Support

Irlam Clinic

Contact Us