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DISCLAIMER - PLEASE READ
To use this system, you will have to enter information about yourself that will be sent to us across the internet. This e-form information is not encrypted, but will be no less secure than a normal email. We can not guarantee that this information will not be seen by others.
I confirm that I wish to use the Repeat Prescription Ordering Online Service provided by Grosvenor Place Surgery and confirm that I have read and accept the disclaimer above.  Please select the Yes option in the box below if you agree to these terms.

 
 

  
  Your First Name *   * You must provide this information.  
  Your Surname *    
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  Your Mobile No.      
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  Item   Strength   Amount    
  e.g. Paracetamol   e.g. 500mg   e.g. 100 tablets    
   

     
         
         
         
         
         
               
  Comments. Please tell us whether you want to collect your script or for it to be sent to Larkhall, Batheaston or Boots Pharmacies.
(Not for medical problems)		      

                                

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