Haywood Pharmacy

3 Trent Close, Great Haywood ST18 0SS

T: 01889 881180

Haywood Pharmacy

REPEAT PRESCRIPTION ORDERING SCHEDULE

DAY & TIME YOU PLACE THE ORDER DAY & TIME WHEN MEDICATION IS READY TO BE PICKED UP**
IF ORDERED BEFORE
10:00 AM ON MONDAY		 CAN BE READY FOR PICK UP ON
FRIDAY AFTER 4:OOPM**
IF ORDERED AFTER 10:00AM
ON MONDAY AND
BEFORE 10:00AM ON TUESDAY		 CAN BE READY FOR PICKUP ON
FRIDAY AFTER 4:OOPM**
IF ORDERED AFTER 10:00AM
ON TUESDAY AND
BEFORE 10:00AM ON WEDNESDAY 		CAN BE READY FOR PICKUP ON
MONDAY AFTER 4:OOPM**
IF ORDERED AFTER 10:00AM
ON WEDNESDAY AND
BEFORE 10:00AM ON THURSDAY 		CAN BE READY FOR PICKUP ON
TUESDAY AFTER 4:OOPM**
IF ORDERED AFTER 10:00AM
ON THURSDAY AND
BEFORE 10:00AM ON FRIDAY 		CAN BE READY FOR PICKUP ON
WEDNESDAY AFTER 4:OOPM**
IF ORDERED AFTER 10:00AM
ON FRIDAY AND
BEFORE 10:00AM ON MONDAY 		CAN BE READY FOR PICKUP ON
FRIDAY AFTER 4:OOPM**

PICKUP OF MEDICATION DEPENDS ON THE AVAILABILITY OF SIGNED PRESCRIPTIONS FROM THE SURGERY.

Collection within the Gt Haywood Area.
Delivery within the Great Haywood Area on request.

We have an arrangement with the following surgeries to dispense repeat prescriptions to patients -

Hazeldene House Surgery, Great Haywood, Stafford, ST18 0SU

First Names:
Last Name:
Date of Birth: (dd/mm/yyyy)
Address:
Phone Number:
Email Address:
Surgery:
Please tell us what medication you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name Strength

If you require more than 10 items, please submit another request.
Comments (any comments that you may have about this service)

CONFIDENTIALITY - TERMS AND CONDITIONS
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The Pharmacy accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

By completing this form, you are agreeing for us to contact you. Any personal details supplied will be used and stored in connection with this enquiry.

Details entered will be sent by email. If you do not wish to send your details by email, you can also contact us by telephone.
I accept the terms and conditions above and understand that by ticking this box I give my consent for Haywood Pharmacy to order, pick up and dispense this repeat prescription.