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Repeat Prescriptions Ordering Service

Repeat Prescriptions Request Form

To order your repeat medication online:
• enter the names of the medications in the boxes below
• enter the required details to identify yourself
• enter your e-mail address to receive an e-mail confirmation of your request

If you need to order more items than there are lines available, simply return to the page and enter the additional items as a new order.

Your prescription order will be processed by your Doctor's Surgery and prescriptions will be collected by us. Please note that you will need to allow 2 full working days (excluding weekends) for the prescriptions to be prepared by the surgery. Your medication will be ready to collect from us in the following two days.


Your doctor may not issue prescription for some of the items you may have requested. If it occurs, you should contact the surgery for an explanation or to speak to the doctor.

Please read our Privacy Notice regarding handling of the details that you submit via this Web site.

When you have entered and checked your repeat prescription request please press the 'Order Prescription' button.

 Fields marked by this icon must be filled in.

First Name:
Family Name:
Date of Birth: Day:       Month:     Year:
Enter email:
Re-Enter email:

Please ensure your e-mail address is correct. An incorrect e-mail address will mean you will not receive your confirmation e-mail.

To lessen any delays in processing your prescription please enter into the box below which doctor you usually see regarding this condition or medication, so that the receptionist knows which doctor may be best able to check and sign your prescription.


Item 1. Name & Strength of Medication:

Item 2. Name & Strength of Medication:

Item 3. Name & Strength of Medication:

Item 4. Name & Strength of Medication:

Item 5. Name & Strength of Medication:

Item 6. Name & Strength of Medication:

Item 7. Name & Strength of Medication:

Item 8. Name & Strength of Medication:

Item 9. Name & Strength of Medication:

Item 10. Name & Strength of Medication:

Please use the freetext box below for surgery or pharmacy notifications specific to your prescription - e.g. to explain that you are ordering early because you are going on holiday.

As soon as you press "Order Prescription" your prescription request will be e-mailed to Knights Pharmacy and the request will be faxed to your Doctor's Surgery by Knights Pharmacy..

Please check your entries above before you proceed.

All the information collected through this form is only provided to your surgery and Knights Pharmacy and used to provide the repeat prescription service. This information is not shared with any other third party.

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