Order Repeat Medication - Manchester Road East Medical Practice

You can use the form below to request any repeat prescriptions from the practice.

Please allow 2 working days for your request to be processed and the prescription to be sent to your chosen pharmacy.

Order Medication

Name

First Name(s) Last Name

Date of Birth

Address

Address Line 1 Postcode

How would you like us to contact you if there is a problem?

Telephone (including SMS)

Email Address

Contact Number

Which medication(s) would you like to order?

Medication

Strength

Dose

Enter each medication and strength/dosage as it appears on your prescription. Add more using the ‘plus’ icon.

Which pharmacy would you like this to go to?

Additional Notes Optional

Name Optional

This field is for validation purposes and should be left unchanged.