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Query my Pharmacy Medication?

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Pharmacy Medication Query

Required fields are marked with an asterisk (*).

Date

**PLEASE NOTE – This is a query form for Pharmacist use ONLY. If completed by a Patient, this form will not be processed**

You can order your repeat prescriptions at any time in the NHS App, without joining a telephone queue or waiting until your GP surgery opens.

You can also easily choose where your prescriptions are sent by changing your nominated pharmacy to wherever suits you.

Download the NHS App or find the same service on the NHS website: www.nhs.uk/nhs-app

Pharmacy Name*

Pharmacy Email address for response*

Pharmacy Contact Name*

Telephone number*

Please complete the patient details below

Patient’s Name*

Date of Birth*

NHS No.*

Medication Name*

How can we assist you?*

*Please make sure all Mandatory fields have been completed

*Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data *

I consent to the practice collecting and storing my data from this form

Are you human?*

This field should be left blank

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Please note this form is not to be used for the following purposes:

Medical matters, Prescription requests, Patient Access requests, Appointment requests or Complaints. Medical matters cannot be dealt with via this form. If you have a query regarding a medical matter please telephone reception to make an appointment to see the appropriate person.

Other forms available

Register as Patient

Please visit our Patient Registration page and fill in the health questionnaire to register as a patient at Teldoc.

Change of Address

Please visit our Change of Name Form to update your details

Provide Feedback

Please visit our Feedback Form to provide feedback, make a suggestion or complaint.

More forms

Please visit the How Do I Portal for more forms

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Visit the How Do I portal for information on how to make an appointment, register at the practice and change your details