Patient Medication Request Form

This form is not to be used for requesting repeat prescriptions.

Please register and make your request online or ask for a copy of the right hand side of your repeat prescription at reception if you need to do this.

Your contact details are needed in case there is a problem with your request

For your request to be considered at least one of the following criteria must apply

If neither of the above criteria apply, your request will not be processed,.
Please make an appointment to see your GP.

  • Please leave details of the medication you require

Please consider asking about the Minor Ailments Scheme where you can receive medication directly from the pharmacist also known as "Care at the Chemist".

Thank you for helping us to ensure a safe prescription ordering system.

Contact Details

Tel: 01706 628628
01706 620800

York House Surgery, 19 York Street,
Heywood - Lancashire
OL10 4NN

Opening hours:
From 8:30a.m. to 6:30p.m. Mon to Fri.
Close once a month, on the second Thursday from 1:00 to 5:00p.m. for training.