Repeat Prescriptions Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=120 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="750" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 85 ><NOBR><div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="735" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="LEFT" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 68 ><NOBR><div> <I><B>Imperial</B></I></div> <div> <I><B>Medical Practice</B></I></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="398" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 56 ><NOBR><div> Appointments:</div> <div> Enquiries:</div> <div> Practice Manager:</div> <div> Fax:</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> 01395224555  /  8am - 1pm and 2pm - 6pm</div> <div> 01395280362  /  9am - 1pm and 2pm - 5pm</div> <div> 01395280364  /  9am - 1pm and 2pm - 5pm</div> <div> 01395279282  /  9am - 1pm and 2pm - 5pm</div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#3366FF HEIGHT= 41 WIDTH="750"><div> <A HREF="practice_information.htm" TARGET="_top" TITLE="Practice Information">Practice Information</A>   |   <A HREF="practice_news.htm" TARGET="_top" TITLE="Practice News">Practice News</A>   |   <A HREF="colleagues.htm" TARGET="_top" TITLE="Colleagues">Colleagues</A>   |   <A HREF="how_do_i.htm" TARGET="_top" TITLE="How do I">How do I</A>   |   <A HREF="test_results.htm" TARGET="_top" TITLE="Test Results">Test Results</A>   |   <A HREF="telephone_advice.htm" TARGET="_top" TITLE="Telephone Advice">Telephone Advice</A>   |   <A HREF="make_appointment.htm" TARGET="_top" TITLE="Make Appointment">Make Appointment</A>   |   <A HREF="prescriptions.htm" TARGET="_top" TITLE="Prescriptions">Prescriptions</A>   |   <A HREF="links.htm" TARGET="_top" TITLE="Links">Links</A>   |   <A HREF="contact_us.htm" TARGET="_top" TITLE="Contact Us">Contact Us</A>   |   <A HREF="imperial_medical_self_care_c.htm" TARGET="_top" TITLE="Imperial Medical Self Care Course">Imperial Medical Self Care Course</A>   |   <A HREF="support_the_practice.htm" TARGET="_top" TITLE="Support the Practice">Support the Practice</A>   |   <A HREF="suggestions.htm" TARGET="_top" TITLE="Suggestions">Suggestions</A>   |   <A HREF="sexual_health.htm" TARGET="_top" TITLE="Sexual Health">Sexual Health</A>   |   <A HREF="how_to_find_us.htm" TARGET="_top" TITLE="How to Find Us">How to Find Us</A>   |   <B>Repeat Prescriptions Form</B></div> </tD> </tR> </TABLE></div> <div> </div> </td> </tr><tr> <td valign="top" height=360 BGCOLOR="#C0C0C0" TEXT="#080000"> <bR> </td> </tr></table></body>