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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
*
First
Last
Date of birth
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Day
Month
Year
Address
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Street Address
City
Postcode
Email
Phone
*
GP Search
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The Waverly Medical Practice, The Health Centre, Galashiels, TD1 2UA
Braeside Medical Practice, Currie Road, Galashiels, TD1 2UA
Mairches Medical Practice, The Health Centre, Currie Road, TD1 2UA
Roxburgh Street Surgery, 10 Roxburgh Street, Galashiels, TD1 1PF
GP surgery not listed
Can't find your GP surgery?
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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 Gala Pharmacy my chosen pharmacy. This means Gala 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.
