Emergency Medication Request

Emergency Medication Request

Please note following review by the Duty Doctor, if it has been determined that this request is not clinically urgent and can safely wait. The request will therefore been moved to the routine prescription queue and will be processed within the normal prescribing timescale of up to 4 working days.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Medication Required

    I understand and acknowledge following review by the Duty Doctor, if it has been determined that this request is not clinically urgent and can safely wait. The request will therefore been moved to the routine prescription queue and will be processed within the normal prescribing timescale of up to 4 working days.
    Please select the pharmacy you would like your online repeat prescription to be sent to.
    Do you consent to being contacted by SMS Text/Email for Appointments/Recalls/Results or Information from our clinicians or medical admin team.
    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.
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Page last reviewed: 16 July 2026