Special Request Prescriptions

Bridge of Allan Health Centre > Clinics & Services > Practice Services > Order a Repeat Prescription > Special Request Prescriptions

You can request an online Special Request Order Form below to order medications that do not appear on your repeat prescription list. This service is only available for registered patients. Acute/Special request prescriptions may take longer than the 2 working days (our timescale for Repeat Prescription requests) – to allow the doctor time to review your medical record and current medications.

Please allow at least 48 hours (2 working days), before your Prescription will be ready for collection. Prescriptions for items not on a Repeat Prescription Order form such as contraceptive pills and antidepressants cannot be provided outwith a consultation with a GP.

The Committee on Safety of Medicines has advised that all GP practices should avoid the long-term prescribing of the following medicines:

Diazepam, Lorazepam, Loprazolam, Lormetazepam, Oxazepam, Nitrazepam, Temazepam, Zopiclone, Zolpidem, Zaleplon.

Please note that these tablets will now NO LONGER routinely be started by practices.

If you are already taking any of the above medicines then you may be invited for a review with your doctor to discuss a plan to step down or stop the medicine. If you would like any more information, please discuss with your doctor.

Complete the Special Prescription Form

Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.

Prescription Special Request Form

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Usual GP *

If you do not know who your GP is insert “not known”

What Medication do you require?

Name of Medication *

Dose *

e.g. 5 mg tabs

Quantity *

Reason for request and when last prescribed

Name of Medication

Dose

e.g. 5 mg tabs

Quantity

Reason for request and when last prescribed

Name of Medication

Dose

e.g. 5 mg tabs

Quantity

Reason for request and when last prescribed

Name of Medication

Dose

e.g. 5 mg tabs

Quantity

Reason for request and when last prescribed

Privacy Policy

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 the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

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