Acute medication request
Please complete this form to request medication that you have taken before, is not on your regular repeat medication and you would like the GP/practitioner/prescriber to issue.
Please give 48 hours for processing.
Please note that the medication request will be reviewed and the clinician may require further information prior to issuing. If the request is not clinically appropriate it will not be issued.
PLEASE DO NOT USE THIS FORM TO ORDER REPEAT MEDICATION. WE WILL NOT BE ISSUING OR REVIEWING YOUR MEDICATION IF YOU USE THIS FORM. THANK YOU.