Request for other non-repeat medication

Please only use this form if you are requesting medication that has previously been prescribed for you but is not on repeat for you. If you've never been prescribed the medication, please use our NEW MEDICATION request form. We will assess the request and some medication can be prescribed without requiring a phone call. For some medication, we will need to call you to clarify details about how the need for the medication.

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Patient's Details
 
Medication request
Please list the name(s) of the medication you require along with the strength and dosing. Please take a picture of the box or previous prescription if you're unsure and you can upload this below.
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
We cannot guarantee to meet the timeframes you specify but will do our best

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.

 
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