Order Repeat Medication - Manchester Road East Medical Practice

If you do not have a Patient Services account, you can use this form to request any repeat prescriptions from the Practice.

Please allow 2 working days before collecting your prescription.

In future you may wish to register for the NHS App to have the ability to Book or Cancel an Appointment, Request a Repeat Prescription, View your Medical Records and more without visiting the practice.

Order Medication

Please complete the online form below to request a repeat prescription.

Title

First Names

Surname

Date of Birth

Address

Street Address Address Line 2 City Postcode

Contact Number

Email Address

Enter Email Optional Confirm Email Optional

Enter each medication and strength on your prescription

Medication

Strength

Dose

Pick Up Point Optional

Additional Notes Optional

Comments Optional

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