Register for our prescription collection and delivery service

To take advantage of our FREE services (including Prescription Collection and Delivery) please complete the following consent form:

• Firstname
• Lastname
• House no or name
• Address 1
• Address 2
• Postcode
• Telephone
• Email
• Surgery
• Please assist me by:
• The FREE collection of prescriptions on my behalf from the surgery above and when applicable receiving them electronically from the surgery:
• The FREE ordering of my prescriptions from the surgery above:
• The FREE telephone / email reminder when my prescription is due so that I can confirm my order: