Pharmacy medicines are sold at the professional discretion of our pharmacists. Please answer the following questions accurately to allow our pharmacy team to check that this product is suitable for the intended patient (s). All information provided will be treated confidentially and will only be available to the pharmacy staff processing your order. The pharmacy team may need to contact you by phone for additional information. Please ensure that the contact details you provide when you check out are correct. Please note, the pharmacy team reviewing this order only have access to the details on this form. They don’t have access to any other patient information that may have been provided either in store or online on previous occasions.
Don't forget to save your form to be able to add to cart