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Item Request Form
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Add your personal details below. Please enter the details your GP will have on record so we can match you to your GP.
Name
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First
Last
Date of birth
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Day
Month
Year
Address
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Street Address
City
Postcode
Email
Phone
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GP Search
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The Well Medical Practice, 138-144 Windmillhill Street, Motherwell, ML1 1TA
The Clyde Practice, 138-144 Windmillhill Street, Motherwell, ML1 1TB
Knowetop Medical Practice, 138-144 Windmillhill Street, Motherwell, ML1 1TB
Dr Clark & Partners within Houldsworth Centre, Wishaw Library, Kenilworth Avenue, Wishaw, ML2 7BQ
Wishaw Surgery, Logan Practice, Level 3, Houldsworth Centre, Kenilworth Avenue, Wishaw, ML2 7LP
Modyrvale Medical Centre, Toll St, Motherwell, ML1 2PJ
Orchard Medical Centre, 41 Ladywell Road, Motherwell, ML1 3JX
Newarthill Medical Practice, 15 Carfin Road, Newarthill, Motherwell, ML1 5AG
MacInnes Medical Practice, 60 High Street, Newarthill, Motherwell, ML1 5JU
Mossend Surgery, 494 Main Street, Mossend, Bellshill, ML4 1DQ
Bruce Medical Centre, 2 Pollock Street, Bellshill, ML4 1QD
Auchinraith Medical Practice, Victoria Street, Blantyre, Glasgow, G72 0BS
Victoria Medical Practice, Blantyre Health Centre, 64 Victoria Street, Blantyre, Glasgow, G72 0BS
Oak Lodge Medical Practice, 32 Miller Street, Hamilton, ML3 7EN
Holytown Surgery, 43-45 Main Street, Holytown, Motherwell, ML1 4TH
GP surgery not listed
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How would you like to get your prescriptions?
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Collect in store
Delivery
How would you like to order?
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Type medication
Take a picture of repeat slip
Items Requested
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Please enter one medication per line
Items Requested
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Accepted file types: jpg, png, gif, webp, tiff, psd, raw, bmp, heif, indd, jpeg, Max. file size: 10 MB.
Upload repeat slip
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I agree to make Brandon Pharmacy my chosen pharmacy. This means Brandon Pharmacy retain my repeat prescription re-order slip, request prescriptions from my surgery and collect prescriptions on my behalf either in person or by electronic transfer.
