Stockton Heath Medical Centre > Forms > Prescription Request

Prescription Request

This form is not to be used for clinical enquires

Order your prescriptions online with the form below. You must be a permanently registered patient with the Practice before we can accept your request.

Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission. It is important to enter your correct email address failure to do so will result in non-delivery of your request.

We will contact you by email or telephone if there is any problem which may delay you being able to collect your prescription. Please do not order more than 10 days in advance unless you are going on holiday as we may not be able to issue if too early. You will need to notify us of any reason for early request.

Repeat Prescription Request

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice. Please ensure you state dose and strength e.g. Aspirin 75mg one tablet daily.

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Are you ordering your medication LESS than 10 days?

Yes

Please state the reason for your early request

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Acute items that are not on your repeat list will take longer to process

An acute prescription is a ‘one-off’ prescription which the GP has decided not to add to your repeat list of regular medication. This may be a prescription for a short course of treatment or for a new medication until you are stabilised on it. Some medication is not suitable for prescribing on repeat prescription. The medical centre may need to contact you to discuss your prescription request.

Common reasons for delay include requests for painkillers where it is unclear what you are taking them for or where they are being taken for a reason which is different from the initial reason they were prescribed. It is important that particular care is taken with painkillers to make sure they are being prescribed safely. Other examples which can cause delays are requests for medication where a review needs to be carried out to establish that continued prescribing is appropriate.

Acute Medication Request (please include name, strength and dose)

Requests for acute prescriptions take longer to process because the GP needs to review your medical records to determine the appropriateness of the medication you have requested. Please Note: Acute requests may not be authorised by the Doctor.

Please state clearly what this medication was prescribed for

Are you requesting it for the same symptoms?

Yes

Please describe full details of the condition for which you are requesting it

Prescriptions will be sent to your nominated pharmacy direct. We recommend ordering when you have a weeks’ supply of your medication left as we are unable to issue repeat prescriptions at shorter notice.

Full name and address of nominated Pharmacy for collection *

Please arrange this with your pharmacy. Incomplete details will result in a delay to your prescription.

Your Confirmation

I confirm this request is for medication only

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.

Your consent *

I consent to the practice collecting and storing my data from this form.

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Prescription Request

This form is not to be used for clinical enquires

Prescription Items

Acute items that are not on your repeat list will take longer to process

Privacy Policy

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