Request for New Medication

If you are looking for a new medication that you have not had before please complete the form below.

We will be in contact in the next 2 working days by call or text to organise your prescription. 

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

Maximum file size: 54.53MB

Please upload your files to the practice here. We accept tiff, jpg, png, gif, txt, Word and pdf files, up to a total upload size of 10MB.
Which Barclay Medical Practice branch are you registered with?

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.