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Please complete this form to allow us to order, collect and deliver your prescription.

Details Form

Patient One
or
Patient Two
Doctors Name
Surgery Name
Your Name
Date of Birth
Address 1
Address 2
Town
Postcode
Email Address
Telephone
Delivery Details

Click here to order your repeat medication,

Medication - Patient 1

Enter each drug and strength on your prescription.

Drug 1. Strength ( + ) add another row

Medication - Patient 2

Enter each drug and strength on your prescription.

Drug 1. Strength ( + ) add another row

Special Instructions

Please collect from surgery (Ivybridge/South Brent only)

I will post or contact you

I authorise Ivybridge Pharmacy to order collect and deliver my prescription

 

Alternatively, contact us at the address below:

Ivybridge Pharmacy Ltd
Unit6 The Watermark,
Erme Court,
Ivybridge.
Devon
PL21 0SZ.

Ivybridge Pharmacy is a limited company registered in England and Wales. Reg. No.: 10945882
Reg. Office: Ivybridge Pharmacy Ltd, 7 Erme Court, Leonards Road, Devon, PL21 0SZ.
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