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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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Waverley Medical Centre, Dalrymple Street, Stranraer DG9 7DW
Glenluce Surgery, Four Winds, Newton Stewart DG8 0PU
Sandhead Surgery, Piggery Road, Sandhead, Stranraer, Wigtownshire, DG9 9DP
Mull Of Galloway Practice, Drummore, Stranraer, Dumfries & Galloway DG9 9QQ
GP surgery not listed
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Enter details above
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
Please sign below
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I agree to make Stranraer Pharmacy my chosen pharmacy. This means Stranraer 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.
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