Request acute medication

For prescription medications you have had before which are not on repeat, please complete the form below outlining the medication you require e.g. iron supplementation, inhalers, creams etc. If approved, this will usually take up to 3 working days to issue to your nominated Pharmacy.

This form is NOT for REPEAT or URGENT medications. If a repeat medication request is sent through via this form it will be discarded.

Please note: GP Practices are guided by NHS England on which medications should not routinely be prescribed in primary care. This means that your doctor, or other prescriber, will not routinely prescribe medicines for minor health conditions that can be purchased over the counter. NHS Over The Counter Leaflet (external pdf). Over the counter medications will only be prescribed in very rare circumstances, and on a case-by-case basis. The reasons for this need to be outlined on the form below.

Request acute medication

Step 1 of 2

Full Name Required

Date of Birth Required

Contact Number (preferably Mobile) Required

What medication would you like to request? RequiredPlease note this form will ONLY be accepted if you have been on this medication before & it is NOT a request for antibiotics. If you would like to request these medications you must request an appointment.

Please outline any further information for your request e.g. when you last took it & what is it for Required

If this medication can be bought over the counter then please explain why you are requesting a prescription for this Optional

Is your request for an inhaler? Required

Which pharmacy would you like your prescription to be sent Required

If other please state the pharmacy name & postcode Required