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Repeat Medication Request Form

Manor View Practice is an NHS GP surgery. We do not sell or dispense medicines and we are not an online pharmacy. We issue NHS repeat medications, which are sent electronically to the pharmacy you choose, where you collect your medicines.

Repeat Medications Request

Please allow 4 working days for your medication to be processed, this does NOT include weekends and bank holidays. Please only call the practice for a medication query if it has exceeded 4 working days.

Only requests for items on repeat will be issued.

Please complete the form below to request your repeat medication.

You request your medication during the dayIt will be ready to collect at the end of the day
MondayFriday
TuesdayMonday
WednesdayTuesday
ThursdayWednesday
FridayThursday

Useful Information

Each medicine has two names: the generic name and the brand name. Where possible we use the generic name because this is usually much cheaper for the health service. Because of this you may notice a change in the colour, shape or size of your medicine. Do not be concerned if you are still receiving the same medicine of the same quality; only the appearance has changed.

Free Medication

Medication is free to: pensioners, children under 16, people under 19 and in full time education, pregnant and mothers of children under one, people suffering from one of a number of specified individual conditions, people on income support or family credit.

Repeat Medication Request Form

Personal Details


Medication Required

Medication 1
Medication 2
Medication 3
Medication 4
Medication 5


Other Items

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.