Prescription Collection - Community Support

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Form to collect details of prescription collections, for those in need

Email *

Who are you completing this form on behalf of *

If you are completing this form on behalf of Another, you must be a Council officer or working for a recognised support organisation.

First name *

Please enter your First name as held by the Pharmacy.

Surname *

Please enter your Surname as held by the Pharmacy.

Address *

Please enter the First Line of address, including House name/Number and Street/Road

Postcode *

Please enter the Postcode for your address, where you live. We cover ALL OX11 and some OX12, OX13 and OX14 postcodes near Didcot.

Telephone Number *

Your telephone, either mobile or landline - no country codes please

Please select which Pharmacy does your medication need collecting from *

Which Pharmacy has your Medication, select one listed or input Other... if not listed

Day Lewis Pharmacy - GWP (OX11 6GD)

Woodlands Medical Centre - Lloyds Pharmacy (OX11 0BB)

Didcot Health Centre - Lloyds Pharmacy (OX11 7JH)

Sainsbury's Didcot - Lloyds Pharmacy (OX11 7ND)

Boots - Orchard Centre (OX11 8RG)

Other:

NHS Prescription Charges *

If you are not exempt or haven't paid your Pharmacy over the phone, you will need to electronically arrange payment to the person assisting you in advance, via something like PayPal friends and family. They will contact you if you select "Other" to arrange payment of NHS charges.

I'm Exempt from NHS prescription charges

I've pre-paid my charges over the telephone

Other:

When does this need collecting? *

If not immediately available and As Soon As Possible, please give a date for collection.

YYYY

How many packages of medication need collecting?

Any other information?

Is this a repeating requirement or any special collection or delivery instructions?

Send me a copy of my responses.

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