Does your prescription have repeat? *

• Yes
• No

If yes, then select how many

-- Please Select --1 2 3 4 5 6 7 8 9 10 11 12 Other

If other then please specify

Please enter your doctor details, including name, address and telephone no.: *

Please confirm that you have a valid NHS prescription, once all the required above fields are filled ,post your Original Prescription to our Freepost Address .We will be unable to dispatch your prescription medicines to you until we receive your original  *

• I agree

* Required Fields