Note

If you have a prescription and are unable to get to the Pharmacy for any reason, you can complete the form to the right, using the information from the prescription and we will either have your medicines ready for collection or we can deliver them to you.
 
Please note that we MUST see the original prescription before we can hand over the medicines, so, you need to bring it with you to the Pharmacy, or make sure someone, with the prescription, is available to receive delivery.

Prescription request

If you are a regular customer, requesting items that you have had before, you may abbreviate but otherwise please write the full description exactly and completely as it appears on the prescription.
 
 
Date of Birth *
 
 
Date prescription issued *
 
 
 
Prescription item(s)*
No prescription item(s) has been added yet.
 
I will collect from the Pharmacy on
/ /
at    (approx time) Clear Date
Please deliver on
/ /
at    (approx time) Clear Date

(An adult should be available to receive medicines and hand over prescription)