Pharmacy Questionnaire

Tell Us About Medicines You No Longer Take

If there are any medicines on your repeat prescription that you no longer need or don’t take, please let us know by completing this short form.

Keeping your prescription list up to date helps your GP and pharmacy make sure your records are accurate and safe — and it prevents unnecessary repeat issues.

Pharmacy Questionnaire

Your personal details

Name
Name
First name
Last name
Please use format day/month/year e.g. 12/05/1979

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