Acute Medication Query Request

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)

If you require medication not on your repeat prescription please read the following information and fill in the form.

All Medications have potentially harmful interactions and side effects. If your request for a non repeat medication is declined it will be for your own safety.

Inaccurate or incomplete information may result in a request being refused.

Prescriptions take 48 hours to process.

Medication for a new illness is likely to be refused until you are assessed by one of the doctors, either in surgery or in some cases over the phone.

Your Personal Details
Medication Requested

We will reply to your request to let you know the outcome within 48 hours. If your request is successful we will send the prescription directly to your nominated pharmacy. Your request may be declined or you may be asked to make a routine Doctor appointment if further information is required.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
Previous Page  
Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.