Repeat Prescription Request Form


 The majority of repeat prescriptions are issued via our computer.  When you require a repeat prescription please complete the tear off slip on the previous prescription and return it to the surgery.  If this is not available please write all your details clearly on a sheet of paper (name, date of birth, name of item, strength, dosage and the local chemist of your choice).  The 2 pharmacies in Peel and 1 in Kirk Michael operate a system whereby they collect prescriptions from the surgery and the patient can then collect their items later in the day directly from the pharmacy. 

 You can order online from our website or

by signing up for Patient Access where you can book appointments and order repeat prescriptions on line


We regret that we are unable to accept requests for prescriptions over the telephone.  This is to avoid mistakes and to guard against the telephone lines from becoming too busy and preventing any emergency telephone calls from getting through.

Important Information

Saving details help

You do NOT have to register to order your repeat prescription - it is your choice.
If you do not wish to register simply use the form below to place your order.

There are some advantages to registering and you can read about them here. To register click the link above.

Choose a Patient

Patient Details


You may request up to twenty separate items. Enter each drug and strength on your prescription. Untick the 'Required' box if you do not require the item this time.
Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending
Drug Quantity and/or Strength
e.g. 1mg once a day


Please do not include medical problems here - these should be discussed with your doctor

Sending Your Request

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About This Form

Fields marked with a red asterisk are

This form uses cookies to store your information for next time.

The information is stored on your computer when you send your request or when you switch patients - but only if you check the 'Remember my details...' box.

To save details for a second person use the radio buttons at the top of the form. To save details for more than two people or if you are having trouble with cookies, register with the prescription service and your details will be saved securely in the online database and recalled when you log in. Registering is quick, simple and free.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential. Where appropriate this data is deleted two months after its creation.

By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of ordering a repeat prescription.