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Castle Place Practice > Forms > Non Repeat Request Form

Non Repeat Request Form

Order your non repeat request online with the form below. You must be permanently registered with the Practice before we can accept your request.

Please note: Any repeat medication that is submitted on this form will not be processed.

Prescription available

RequestedMondayTuesdayWednesdayThursdayFriday
AvailableThursdayFridayMondayTuesdayWednesday

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.

Non repeat request form
Please use format day/month/year e.g. 12/05/1979
This is required should a clinician need to contact you.
Have you had this medication before?
If you marked YES – Have your symptoms changed since you last had this medication?
Have you spoken to a GP or clinician about this request?

Privacy Notice

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 Notice 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.