Acute Medication Request Form

This form should not be used to order repeat medication.

Unfortunately, we will be unable to prescribe any medication if you have not discussed your treatment with a healthcare professional within the last 2 months.

The following medication cannot be prescribed without first seeing a healthcare professional.

Co-codamol, Tramadol, Codeine, Dihydrocodeine, MST, Oxycontin, pain patches, Zopiclone, Diazepam, Lorazepam, Temazepam, all antidepressants, Naproxen, Ibuprofen, Diclofenac and all antibiotics. 

Once submitted your request will be reviewed by a clinician. You will be notified of the outcome of your request within 72 hours. You may require a telephone consultation based on the clinician's decision. 

Last Updated: 30/01/2024

  • Personal Details

    Date of Birth
    For example, 15 3 1984

  • Medication Request

  • Collection Options

    Please select how you would like us to process your request

  • Consent

    This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow Waterfront Medical Centre to contact you, and to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy for more information on how we protect and manage your submitted data. I consent to Waterfront Medical Centre collecting and storing my data submitted via this form.
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