Prescription order form

Please only order the item(s) you require. We need the name of the drug, the dosage, and how many you need per item. Prescriptions will be ready for collection 48 working hours after ordering.

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Which surgery are you registered with?
Name
This is in case we need to contact you about your prescription.
Please only order the item(s) you require. We require the name of the drug, the dosage, and how many you need.
Where should we send your prescription?