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    • Order Your One-Off Medication
      For acute prescriptions only and NOT repeats.

    Please complete the form below to order a one-off prescription that hasn’t been issued to you for more than 30 days.

    This will be sent to our Prescription Team who will deal with your request. They will only need to contact you if there are any problems.

    Please allow the team at least 72 hours to process this request, excluding weekends and bank holidays. We will endeavour to process your request so that you do not run out of medication and we will contact you if you require a consultation prior to issuing this request.

    Patient Full Name (required)

    Patient DOB (required)

    Patient Email:

    Registered Practice:
     Retford Harworth Misterton Gringley

    Name of the Pharmacy you would like to collect your medication from:

    Name of the drug required:

    Original prescriber name:

    Please state why you are requesting the drug and what condition you are using it for if it is not one of your usual repeat medications:

    Please enter the 4-digit code shown below for security:
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    By submitting this form you hereby state that the above is a true account.