Queen's Road, Aberlour, AB38 9PR

Telephone: 01340 871210

Fax: 01340 882103


Current time is 03:56 - Sorry, we're closed

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
  • 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
    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.