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Request for Medication not on Repeat

If you feel that you need some medication that is not on your repeat prescription form i.e. something that the GP has given you for a condition in the past, or perhaps medication which you have been prescribed recently to see if it is helpful for your condition, you will be required to email stating: 'Request for Medication not on Repeat'.

Allow at least 48 hours for the GP to deal with this request.

If you cannot email the details please make an appointment with the GP.  Please note that the GP may want to see you before issuing a prescription.  The information we require on the e-mail request is as follows:

  • Name
  • Address
  • Date of Birth
  • Contact Telephone number (specify when not to call)
  • Date required
  • Medication details:
    1. Name of the medication (copy from original pack)?
    2. Dosage?
    3. How often you take the medication?
    4. Who first prescribed the medication and when?
    5. When was the last time you received this medication?
    6. Why was the medication prescribed?

You can also download this document and e-mail the information if this is easier.

To use this form on smartphones or tablet devices you must install the free Adobe Acrobat Reader first.  Then when you open the file in the smart phone or tablet - make sure you select 'open in Adobe'.  Otherwise the form fields cannot be filled.

Request for medication not on repeat

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