Pharmacy Consultation Form Private

Pharmacy Consultation Form

Please allow for some time for our pharmacy team to process and triage your information and you will receive a call later today

This is a private service. A pharmacist will contact you today to triage you and before treatment can be provided, you will be asked to pay a fee of £35

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First Name

Last Name

Date of Birth

Mobile Number

Email

Do you have any allergies?

Yes
No

Are you currently taking any regular medication?

Yes
No

Please describe your health concern

Please be informative about your medical issue as this information will help the pharmacist in their medical advice and prescribing decision

(Optional) Photo or report upload

Click or drag a file to this area to upload.

Images of skin conditions or hospital letters can be useful in helping the pharmacist deal with your problem