12 High Street, Fochabers, IV32 7EP

Telephone: 01343 820247

Fax: 01343 829930


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Medication Not on Repeat Online Form

Form Completion

One form submission for each medication required

Please remember that it can take up to 48 hours, or 2 working days for the Practice to process your request; thereafter it can take another day for the Pharmacy to process.

Medication Not on Repeat

This form is to be completed for any medication that is not on your Repeat Prescription
  • Date Format: DD slash MM slash YYYY
  • Please let us know your main telephone contact number
  • Please let us know when we cannot call you. We cannot guarantee when we can call you. Enter N/A if we can call you at any time
  • It is more helpful if the name is copied from the original packaging
  • Enter the dosage of the medication
  • How often do you take the medication
  • Who prescribed the medication and when?
  • Reason that the medication is taken
  • Date the last medication was prescribed
    Date Format: DD slash MM slash YYYY
  • Let us know the date the medication is expected to run out
    Date Format: DD slash MM slash YYYY
  • Please provide any additional medication that will help the Pharmacist, GP, or Prescribing Nurse with your request
  • This field is for validation purposes and should be left unchanged.