Repeat Online Prescription  Form

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Personal Information

Medical Information

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Pharmacy details

In order to provide your care we need to collect sensible personal and medical information. We recognise the importance of protecting data personal medical records in all that we do, and take care to meet our legal and other duties, including compliance with relevant law, Medical Council regulations and guidance. Under the General Data Protection Regulation (GDPR) Central Park Medical is obliged to ensure patient data, supplied as part of the patient process.

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