Request

My

Medication

Use this form to request your medication

Once we receive your request we will contact your surgery on your behalf. Allow 3 to 5 working days for your medication to be ready for collection. If you have any questions about your prescription, please do not hesitate to contact us

Full Name*

Address*

Date of Birth

My Telephone No.*

Select your GP Practice from the list

Enter your GP/Practice details if not on list above

List the medication you require here

Add a Message

I confirm that I am giving Bayswater Pharmacy consent in requesting my prescription from my Gp surgery and also consent in allowing Bayswater Pharmacy to be my nominated pharmacy with regards to electronic prescrition service.

Monday - Friday	9:00 AM — 7:00 PM
Saturday	9:00 AM — 6:00 PM
Sunday	11:00 AM — 5:00 PM
2 Apr, 5 Apr, 3 May, 31 May	Closed