{"id":36928,"date":"2024-11-06T12:14:03","date_gmt":"2024-11-06T12:14:03","guid":{"rendered":"https:\/\/kincoradesignstudio.com\/ashdown\/?page_id=36928"},"modified":"2024-11-06T12:55:33","modified_gmt":"2024-11-06T12:55:33","slug":"repeat-prescriptions-form","status":"publish","type":"page","link":"https:\/\/kincoradesignstudio.com\/ashdown\/repeat-prescriptions-form\/","title":{"rendered":"Repeat Prescriptions Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"36928\" class=\"elementor elementor-36928\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3546f73 elementor-section-boxed elementor-section-height-default elementor-section-height-default sc_fly_static\" data-id=\"3546f73\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b30769f sc_content_align_inherit sc_layouts_column_icons_position_left sc_fly_static\" data-id=\"b30769f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea28fb8 sc_height_large sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"ea28fb8\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e6b03f5 sc_fly_static elementor-widget elementor-widget-text-editor\" data-id=\"e6b03f5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Patients requiring repeat prescriptions are asked to attend their doctor for review on a regular basis.<\/p><p><strong>You can choose to order your Repeat Prescription in the following way:<\/strong><\/p><ul><li>Please fill out the form below and click send. This enables you to upload your medications and send the form directly to your GP practice.<\/li><li>Download our\u00a0<strong>Repeat Prescription Form here<\/strong>, print it out and complete it. Choose to return your form to us either by email, by post or drop it in to us. You can drop the form in the letterbox at the front of the building.<\/li><li>Alternatively you can pick up a Form from reception, complete it and drop it back to us. Please enclose a stamped addressed envelope if you require your prescription to be posted back to you.<\/li><\/ul>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-055d271 sc_height_huge sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"055d271\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aaa1e4d sc_fly_static elementor-widget elementor-widget-heading\" data-id=\"aaa1e4d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Repeat Prescription Form\n<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38d054c sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"38d054c\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fbc071d sc_fly_static elementor-widget elementor-widget-text-editor\" data-id=\"fbc071d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>Please complete the form below and allow 48Hrs notice for your prescription to be prepared.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2c6afb sc_height_small sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"d2c6afb\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6436294 sc_fly_static elementor-widget elementor-widget-trx_sc_contact_form_7\" data-id=\"6436294\" data-element_type=\"widget\" data-widget_type=\"trx_sc_contact_form_7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f36935-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ashdown\/wp-json\/wp\/v2\/pages\/36928#wpcf7-f36935-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"36935\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f36935-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"form-style-4\">\n\n<div class=\"columns_wrap\">\n\t<div class=\"column-1_2\"><label>Name*<\/label><span class=\"style-icon icon-name\"> <span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/span><\/div>\n\t<div class=\"column-1_2\"><label>Date of Birth*<\/label><span class=\"style-icon icon-calendar-light\"><span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span><\/span><\/div>\n<\/div>\n\n<div class=\"columns_wrap\">\n\t<div class=\"column-1_2\"><label>Your Email*<\/label><span class=\"style-icon icon-email\"><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Email\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/span><\/div>\n\t<div class=\"column-1_2\"><label>Phone<\/label>\n\t<div class=\"phone_wrap\">\n\t\t<span class=\"style-icon icon-phone\"><span class=\"wpcf7-form-control-wrap\" data-name=\"phone-area\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Area\" value=\"\" type=\"text\" name=\"phone-area\" \/><\/span><\/span>\n\t\t<span><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone\" value=\"\" type=\"text\" name=\"phone\" \/><\/span><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div class=\"columns_wrap\">\n\t<div class=\"column-1_1\"><label> Address*<\/label><span> <span class=\"wpcf7-form-control-wrap\" data-name=\"your-address\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please use the address your clinic has on file.\" name=\"your-address\"><\/textarea><\/span><\/span><\/div>\n\t<div class=\"column-1_1\"><label> Pharmacy*<\/label><span class=\"style-icon icon-ambulance\"> <span class=\"wpcf7-form-control-wrap\" data-name=\"name-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name and Address of your preferred pharmacy.\" value=\"\" type=\"text\" name=\"name-address\" \/><\/span><\/span><\/div>\n\t<div class=\"column-1_1\"><span class=\"style-icon icon-ambulance\"> <span class=\"wpcf7-form-control-wrap\" data-name=\"allergies\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Allergies (if any)\" value=\"\" type=\"text\" name=\"allergies\" \/><\/span><\/span><\/div>\n<\/div>\n<div class=\"columns_wrap\">\n\t<div class=\"column-1_1\">\n\t\t<h6> Medication<\/h6> \n\t\t<div data-wpcf7-group-id=\"emails\" id=\"emails-groups\" class=\"wpcf7-field-groups \"><div class=\"wpcf7-field-group\">\n\t    \t<span><label>Medication*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"vendor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g paracetamol\" value=\"\" type=\"text\" name=\"vendor\" \/><\/span><\/span>\n\t\t \t<span><label>Dosage*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"vendor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g 500mg\" value=\"\" type=\"text\" name=\"vendor\" \/><\/span><\/span>\n\t\t\t<span><label>Quantity\/Dose*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"vendor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g 2 tablets\/dose\" value=\"\" type=\"text\" name=\"vendor\" \/><\/span><\/span>\n\t\t\t<span><label>Freq. Taken\/Day*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"vendor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g 3 times\/day\" value=\"\" type=\"text\" name=\"vendor\" \/><\/span><\/span>\n\t\t\t<span><label>Supply*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"vendor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g 30 days\" value=\"\" type=\"text\" name=\"vendor\" \/><\/span><\/span>\n\t   \t<button type='button' class='wpcf7-field-group-remove '>-<\/button><button type='button' class='wpcf7-field-group-add '>+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[emails]\" value=\"1\" \/><\/div><\/div>\n\t<\/div>\n<\/div>\n\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send Form\" \/>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d03e36e sc_height_huge sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"d03e36e\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patients requiring repeat prescriptions are asked to attend their doctor for review on a regular basis. You can choose to order your Repeat Prescription in the following way: Please fill&hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-36928","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/pages\/36928"}],"collection":[{"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/comments?post=36928"}],"version-history":[{"count":13,"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/pages\/36928\/revisions"}],"predecessor-version":[{"id":36951,"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/pages\/36928\/revisions\/36951"}],"wp:attachment":[{"href":"https:\/\/kincoradesignstudio.com\/ashdown\/wp-json\/wp\/v2\/media?parent=36928"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}