Prescription request form

We’re trialling this new form to help us process your prescription requests more efficiently. Please answer the initial screening questions then you’ll be able to enter the medications you’re requesting.

Just a reminder that medications for many minor ailments including headache, hayfever, eczema and thrush can now be bought very cheaply from supermarkets and pharmacies – and that many pharmacies can provide them to you free of charge under the Pharmacy First scheme. Using these services means our GPs can provide more appointments for you.

Mock up – prescription form
Is your medication request from your hospital team?

Please don’t complete this form

When you’re discharged from hospital, you should receive a 7 day supply of medication.

We need a letter from the hospital before we can process any further medication requests they’ve made. Please upload the letter below if you have one.

We’ll check the request then arrange a prescription for you to collect from us or your preferred pharmacy.

Upload a discharge letter >>

Are you requesting Hormone Replacement Therapy (HRT)?
Are you requesting the contraceptive pill or patch?
Are all of the medications you’re requesting either on your repeat prescription OR something we’ve prescribed for you in the last 12 months?

Please don’t complete this form

The only medications you can request via this form are:

  • medications on your repeat prescription list OR
  • medications we’ve prescribed for you in the last 12 months

To request only medications in these categories please instead select YES then complete the rest of the form.

For all other medication requests please call us or go online to book a GP appointment.

We won’t process your request if you ask for medications that aren’t on your repeat prescription or that we haven’t prescribed for you in the last 12 months. 

My details

Please use format day/month/year e.g. 12/05/1979

Items on my repeat prescription

Please copy details of the medication you’re requesting from your repeat prescription slip.

Check your prescription slip to see how many ‘issues’ you have left of each medication. If you have 0 (zero) issues left, the GP will need to re-authorise your repeat prescription and this will take up to 10 working days.

Special request medications (items NOT on my repeat prescription)

  1. Items on repeat prescription will take up to 5 working days for the Practice to process.
  2. It will take up to 10 working days for the GP to consider ‘special requests’ for items not on repeat prescription.
  3. Repeat prescription items which needs re-authorising will take up to 10 working days – this means any items where it says ‘0 issues remaining’ on your prescription slip.
  4. Repeat prescription requests may be declined if re-ordered too early.
  5. Special requests’ for certain types of medications – even if prescribed in the last 12 months – may be declined.
  6. If a medication review is needed, the Practice may not process requests for certain types of medication until after the review.
Please allow up to two extra working days for your pharmacy to collect the prescription from us and prepare your medication.

Privacy policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.