Gossops Green Pharmacy Repeat Prescription Order Form

Asterisk (*) Indicates Required Field:
Patient's Name: *
Patient's Date Of Birth: *
Patient's Address: *
Please include Postcode
Patient's Telephone Number: *
Please include area code
Patient's E-mail Address:
Doctors Surgery: *
Doctors Surgery Address: *
Please Include Postcode
Doctors Surgery Telephone Number:
Please include area code
Do you normally pay for your NHS Prescriptions? *
NHS Exemption:
If you are exempt from prescription charges please specify your exemption
NHS Exemption Number:
Please provide your exemption card number if you have one.
Repeat Item 1: *
Please include Drug name, Strength & form ( e.g Tablets / Capsules / Liquid )
Repeat Item 2:
Repeat Item 3:
Repeat Item 4:
Repeat Item 5:
Repeat Item 6:
Repeat Item 7:
Repeat Item 8:
Repeat Item 9:
Repeat Item 10:
Notes & Comments:
Any other information that may be useful
Please Select Delivery Method: *
Delivery Address:
If different from patient's Address , Please include postcode
I hereby authorise Gossops Green Pharmacy to collect, either in person or by means of electronic transfer, my prescription from the surgery shown above on my behalf. I agree to inform Gossops Green Pharmacy of any changes.:  *
You Must select this Box to Continue

First Time Users:

Please note: If this is the first time you have requested this service from us, you will be asked to complete and sign our “Prescription Collection & Delivery form” at the point of your initial prescription collection/delivery, a hard copy of which will be included with your prescription medication.

Latest News from the Manichem Group
Wednesday, 26 November 2014

On Saturday 29th June 2014, Manichem Ltd was pleased to take part for the 7th year running in the annual Lions Club of Reading Fun Day at Prospect Park in Reading. Continue Reading

Tuesday, 25 February 2014

This month a new healthier blood pressure campaign has been launched at your manichem pharmacy.

Get can get your blood pressure checked at your local pharmacy in the private consultation room. Your Pharmcist can give you free advice on managing your blood pressure through diet and lifestyle and if nessecary reccomend if you need to talk to your GP about your blood Pressure.


Monday, 14 October 2013

Manichem Group now provides a Hajj & Umrah vaccination service at:

Cleggs Pharmacy, Ealing Pharmacy, Erleigh Road Pharmacy, Glenlyn Pharmacy, Grovelands Pharmacy, Gossops Green Pharmacy, Harehills Pharmacy, Horsell Pharmacy, Moreton Pharmacy,  Neath Pharmacy, Tilehurst Pharmacy. Triangle Pharmacy, Victoria Pharmacy, Wednesbury Pharmacy.

By appointment only at: Whitley Wood Pharmacy and Henley Pharmacy


Tuesday, 17 July 2012

You can now buy your health and beauty products online with the New Manichem Direct online Shop, browse hundreds of products from your day to medicines such as pain killer, hayfever medication, vitamins, pregnanacy tests, and also you can buy much much more that you may not find in store. You can also buy beauty brands such a Crystal Clear, La Roche-Posay, Vichy and Dermalogica.

Thursday, 30 June 2011

     You can now order your Repeat Prescription online with your Manichem Pharmacy and either have your prescription medication dellivered to your home or work address for FREE. Please select your manichem Pharmacy to order your repeat prescription.