Medication request online form – Park Road Medical Practice (Rosyth)

Time scales

Please allow 2 working days for your request to be processed, should your prescription be sent direct to the pharmacy you may need to allow approx 7 days for the pharmacy to process the prescription. This is outwith our control. We may not always be able to process prescriptions early to allow for this as it is the way pharmacies work and not the practice. Should your request be urgent please note this on your request.

"*" indicates required fields

Name*

First Last

Date of birth*

Patient Number (if applicable)

Email address*

Enter Email Confirm Email

Daytime telephone number*

Item description

Please use the (+) button at the end of the row to add as many rows as you need for your medications.

List*

Item 1 - eg Atenolol

Strength 1 - eg 50mg

Quantity 1 - eg 28 tabs

Additional info

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy. This information is not shared with any third party organisations. This information is retained for up to 28 days.

Time scales

Item description

Terms & Conditions