Website Design with simple ordering system

Im looking for a website for an online chemist, i have domain, hosting etc sorted but i need a simple system for repeat prescriptions, the design of the site itself i will do but need a system in place to do the following-
1. Customer Registers with the site
2.Fills out basic form,Name, Address, User Name Password etc
3. Selects there local GP/Doctor from list/ Also Chemist Branch
4. Fills out their Medication Required and Submits
5 this will automaticially send email to the specified chemist, order tracking may be an option.
6 Email and text will be returned to customer to say prescription is ready

i could do most of this from an online form builder but i would have to send to central hub rather than specific chemist, also i need when you log back in that the system remembers your last prescription order