Repeat Prescription Request Letter Template UK

The Repeat Prescription Request Letter Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring both editable and printable versions.

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Sample

Repeat Prescription Request Letter Template UK

Editable – Printable

PDF – 1 PDF – 2

Repeat Prescription Request Letter Template UK

1. Patient Information


2. Doctor’s Information


3. Prescription Details


4. Reason for Request

5. Previous Prescription Information

6. Additional Notes or Observations

7. Expected Timeline for Response

8. Signature and Declaration


PDF

WORD

Examples

Repeat Prescription Request Letter Template UK (1)
From:
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
To:
[Name of the Pharmacist/Doctor]
[Pharmacy/Practice Name]
[Pharmacy/Practice Address]
Date:
[Date]
Subject:
Request for Repeat Prescription
Dear [Pharmacist/Doctor’s Name],
Introduction:
I hope this letter finds you well. I am writing to request a repeat prescription for my medication.
Clause 1: Patient Information
Patient Name: [Your Name]
Date of Birth: [Your Date of Birth]
NHS Number: [Your NHS Number]
Clause 2: Medication Details
I would like to request a repeat prescription for the following medication:
– [Medication Name 1], [Dosage], [Quantity]
– [Medication Name 2], [Dosage], [Quantity]
Clause 3: Previous Prescription
My previous prescription was issued on [Date of Previous Prescription], and I have followed the prescribed course as directed.
Clause 4: Additional Information
If you require any further information or if there are any changes to my treatment plan, please feel free to contact me at the details provided above.
Clause 5: Thank You
Thank you for your attention to this matter. I appreciate your assistance in ensuring that my treatment continues without interruption.
Yours sincerely,
[Your Signature]
[Your Name]
Repeat Prescription Request Letter Template UK (2)
From:
[Your Name]
[Your Address]
[Your Contact Number]
[Your Email Address]
To:
[Name of the Pharmacist/Doctor]
[Pharmacy/Practice Name]
[Pharmacy/Practice Address]
Date:
[Current Date]
Subject:
Repeat Prescription Request
Dear [Pharmacist/Doctor’s Name],
Introduction:
I am writing to formally request a repeat prescription for my ongoing medication.
Clause 1: Patient Details
Patient Name: [Your Full Name]
Date of Birth: [Your DOB]
NHS Number: [Your NHS Number]
Clause 2: Medication List
I am requesting the following medications to be refilled:
– [Medication Name 1], [Dosage], [Quantity Needed]
– [Medication Name 2], [Dosage], [Quantity Needed]
Clause 3: Prior Authorization
My last prescription was filled on [Date], and I have been taking the medication as prescribed.
Clause 4: Contact for Clarification
Should you need additional information or clarification, please do not hesitate to reach me at the contact information listed above.
Clause 5: Acknowledgment
Thank you for your prompt attention to this request. I look forward to your response.
Best regards,
[Your Signature]
[Your Name]

Printable

PDF – 1 PDF – 2

Repeat Prescription Request Letter Template UK