In order to provide the contraceptive pill safely we need to ask you a number of questions.
Use this form to submit your next repeat prescription request.
If you are having any problems with your medication or would like to consider alternative contraception options, please speak to one of our Practice nurses, who will be able to advise you, or refer you to the Doctor as appropriate.
You can use this service if you:
- are registered at the surgery
- have been invited to do so
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on The Sixpenny Handley Surgery 01725 552500 or The Broad Chalke Practice 01722 780282.