Online request for Medication NOT on Repeat

This form is designed to obtain appropriate information from our registered patients who, for various reasons, need to request medication that has not been placed on repeat issue by the GP. This is usually for chronic conditions or when a hospital has advised certain medications.

This form is NOT to ask for prescritpions if you are unwell or need medical treatment, e.g antibiotics. Instead submit an online consultation for non urgent medical advice by Clicking HERE

These prescription requests will be reviewed by the doctor/Surgery pharmacist to understand the reasons for your request and to avoid clinical errors.

Note – Submitting this request DOES NOT mean your prescription will automatically be issued and you may need to have a review or further discussion with your GP/Surgery Pharmacist

If you have been seen privately and given a private prescription, this form DOES NOT permit this to be converted to an NHS prescription. Instead you will need to provide details and discuss things further with a GP/Surgery Pharmacist


Non Repeat Medication Request

Your Details


We may contact you to provide a photo of the packet or any letter from the hospital.
After submitting this form the GP/Surgery Pharmacist will review this information and respond within 5 working days. Providing all the appropriate information will help to speed up this process. If your request is urgent, you will need to discuss this with the doctor/Surgery Pharmacist. Please contact reception for details.