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Your Details

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I give my consent for the following areas:

✔ Order my repeat prescription from the surgery (if applicable)
✔ Take my completed repeat prescriptions request slip to the surgery
✔ Collect my prescription from the surgery
✔ Delivery my medication to the address stated above
✔ Store my medications securely to the pharmacy
Consent: any confidential information supplied will be processed and used for the purpose above. This may also include:
  • Sharing information with your GP practice
  • Storing for record keeping purposes

Earls Court Chemist will not pass your details on to third parties. Every effort has been made to protect your's confidentiality.

I understand that i can change or amend this consent at any time and will inform Earls Court Chemist at the earliest opportunity.

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