Newhall Surgery_ ______________
PHARMACY COLLECT
I would like my repeat prescriptions to be forwarded to the following pharmacy
and I will collect it from there after the usual 48 hours.
Boots, Swadlincote
Brennans
Dean & Smedley, Newhall
Dean & Smedley, Swadlincote
Dean & Smedley, Woodville
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Manor Pharmacy
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Sainsburys, Swadlincote
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Quantum Delivery Service **…...
** Please remember that once this is
set up we will continue to supply all of
your prescriptions to the pharmacy of
your choice until further notice. You
will need to inform us of any
changes**
** Quantum Pharmacy provide a
Delivery Service. Deliveries are AM /
PM / Evenings to Home or your place
of Work, you can just choose the slot
you require.
Name………………………………………..DOB ………………….
Address ………………………………………………………………
I confirm that I wish my prescriptions to go the above pharmacy.
Signed ………………………………
Date ………………………….
Office use
Pharmacy Updated on Patient Record (date) …………… …….. Completed by …………………….
You have signed up to the “Pharmacy Collect” Service……
WHAT ARE THE BENEFITS OF SELECTING A
PHARMACY FOR PRESCRIPTION COLLECTION
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Only one trip to make!
No Queuing at the Surgery to collect your prescription.
Your prescription items will be dispensed ready for your collection at
the selected pharmacy after the usual 48 hours.
Possible delivery of your prescription to your home if you are unable to
collect yourself (NB to be arranged by yourself with your selected
pharmacy
Have you signed up for the Avoid the Queue Online Prescription and
Appointment Service? Please ask at reception for further details.
WHEN YOU HAVE HANDED THIS FORM IN TO RECEPTION PLEASE
THEN CONTACT YOUR CHOSEN PHARMACY TO FILL IN THEIR
CONSENT FORM AND ALWAYS INFORM THEM WHEN YOU HAVE PUT
A REQUEST FOR MEDICATION IN TO US SO THEY KNOW WHEN TO
COLLECT YOUR PRESCRIPTION. THANK YOU!