Copy exactly the details from a prescription slip you have received from the practice.
Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.
to discover how we protect and manage your submitted data.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.