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.

Please ensure you complete ALL of the sections marked with an * otherwise the form cannot be sent.
Name*
First Last
Date of birth*
DD slash MM slash YYYY
Patient number (if applicable)
Email address*
Enter Email Confirm Email
Daytime telephone number*
You can add up to 12 items on this form. As you type in each item another set of boxes will appear.
You can add up to 12 items on this form. As you type in each item another set of boxes will appear.
Item 1 - eg Atenolol*
Strength 1 - eg 50mg
Quantity 1 - eg 28 tabs*
Item 2
Strength 2
Quantity 2
Item 3
Strength 3
Quantity 3
Item 4
Strength 4
Quantity 4
Item 5
Strength 5
Quantity 5
Item 6
Strength 6
Quantity 6
Item 7
Strength 7
Quantity 7
Item 8
Strength 8
Quantity 8
Item 9
Strength 9
Quantity 9
Item 10
Strength 10
Quantity 10
Item 11
Strength 11
Quantity 11
Item 12
Quantity 12
Strength 12
Additional info
Terms & Conditions

You can request a prescription by completing and submitting an online form. By completing this form you agree to read and accept our terms and conditions
1. The service is provided only to request prescriptions. It is not to be used to request advice or assistance on any other matter.
2. You can order any items prescribed, not just repeat items.
3. If the date for your next review with a doctor or nurse has passed you will be asked to make an appointment.
4. Your prescription will be ready for collection from the surgery two working days after your request has been submitted.
5. Absolute confidentiality is not possible because we cannot guarantee the security of the Internet. If you are not comfortable with this arrangement you may prefer to order your prescription in person or by post.
6. An email confirming your request will be sent to the address you provide on the form on the following page.
7. The practice cannot be held responsible for any delay in receiving your request, nor any technical failure of the system. Please make sure you order prescriptions in plenty of time.
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Tick the box before sending the form.

Time scales

Terms & Conditions