Community Pharmacy Repeat Medication Request Form

(This form is ONLY for a Community Pharmacy to request a repeat prescription on behalf of vulnerable patients in the absence of access to the NHS App)

Important Information

This request form is only for ordering of repeat medication that is written on the right-hand side of the prescription list.

All non-repeat items will not be processed via this form.

All repeat medication requests should usually be made via the NHS App. Community pharmacies should obtain proxy access through the patient, with the patient’s consent.

We recognise that some vulnerable patients may not be able to access the NHS App. Only in these circumstances may this form be used to request repeat medication.

Alternatively, you may complete the right-hand side (RHS) of the most recent repeat prescription. Community pharmacies can print the RHS form from the patient’s last EPS prescription and place it in the prescription box at the practice.

🚫 This form must NOT be used to request non-repeat medication (i.e. medication that does not appear on the right-hand side of the prescription).🚫

Processing times

  • Requests will be processed by the practice within 2 working days
  • Please allow a minimum of 3 working days for the community pharmacy to receive the prescription via EPS

Requests submitted too early will either be rejected or post-dated to the appropriate due date. To avoid unnecessary delays, please ensure prescriptions are requested only when they are due.

Please do not contact the practice unless the request has not been processed within 3 working days.

Repeat Prescription Request Form – Community Pharmacy ONLY

Declaration:

The items requested on this form are needed for this patient and that we have contacted the patient and only ordered the monthly prescription items. Any repeat item that has a quantity that exceeds 1 month’s supply has been reviewed with the patient and have been added to this order because the patient requires it.
Please tick to acknowledge:
Name of Responsible Pharmacist (on the day of this request):

Medication Details

You must enter the name of medication, the strength and dose of your medication needed as written on the right hand side of your prescription.

Thank you for filling out the form

All medication requests will go to the patients’ nominated pharmacy. Please allow 3 working days for this process to be completed. Repeat prescription requests will be randomly audited by the Safe Prescribing and Medicines Management Team to ensure adherence to practice policy. Please take a moment to check your answers, then click the Submit button below to send it to our team.