Secure Prescription Request Form

To request your repeat medication prescription, please fill out the form below:

If you are having trouble submitting a Prescription Request Form, please email your request via the button below:

Prescription Request Form

  • Patient Name
  • Required Medication

    Complete the form below for each medication and strength on your repeat prescription. Please Enter Yes (Y) or No (N) in the "Required" box if you would like to order the related medication.
  • 1) Medication1) Dose1) Strength1) Required?
  • 2) Medication2) Dose2) Strength2) Required?
  • 3) Medication3) Dose3) Strength3) Required?
  • 4) Medication4) Dose4) Strength4) Required?
  • 5) Medication5) Dose5) Strength5) Required?
  • 6) Medication6) Dose6) Strength6) Required?
  • Do you require more than 6 items?
  • From where would you like to collect your prescription?
  • Where is your prefered Pick Up Point?
  • Additional Comments

Opening Hours

Mon: 8.20am – 5.30pm
Tues: 8.20am – 5.30pm
Wed: 8.20am – 5.30pm
Thurs: 8.20am – 5.30pm
Fri: 8.20am – 5.30pm
Please note: The practice is closed from 1.00pm – 1.45pm Every Wednesday for staff training.

Out of Hours

Out of hours care is provided by NHS 24

Please note this is for urgent and emergency problems only.

We offer early and late surgeries during the week please ask the receptionist for appointment availability


Call: 01292 264 260
Fax: 01292 292 160


Fullarton Medical Practice
40 Dalblair Road
Ayr, KA7 1UL