Wallingford Medical Practice

Providing NHS services
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Fill out a simple online form to get advice and treatment by the end of the next working day.

Medication request form

Medication request form


Please only use this form if you are requesting an item that is not available to order via your Patient Access or NHS App account, please continue to request your regular repeat via Patient Access or the NHS App.

If you have not signed up please refer to our news post “ Prescription Requests from 1st September ” for further information.

Complete the Medication request form

Please note fields marked with * must be completed, failure to do so will prevent the form being submitted.

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

Prescription Items

Copy exactly the details from a prescription slip you have received from the practice.

Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.

Please Note: Special requests may not be authorised by the Doctor. If you do not require any special Medication request/Query please state “None”. this box must not be left blank.

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.
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.