MX Services
Dressings and ostomy supplies
Erectile Dysfunction Service
Minor Ailments
Morning after pill
Medicines Use Review
Order My Prescription
Palliative care Pharmacy Lancashire
Passport Photos
Prescription Collection + Delivery
Stop Smoking Service
Read Blog
Travel Clinic
MX Travel Clinic
Hajj and Umrah
Tick borne Encephalitis
Vaccinations
Flu Service
Hep B Vaccination service
Pneumonia Jab
Shingles
Alphega Pharmacy App
Contact Us
Please complete the form below to order your prescription and arrange delivery or collection. Please allow THREE working days for your medication to be delivered
Prescription Order Form
*
Indicates required field
Patient Name:
*
First
Last
Please enter your name
Date Of Birth
*
Address
*
Please enter your address
Town
*
Postcode
*
Please enter your Postcode
Email
*
Please enter your e-mail address
Surgery
*
Doctor
*
Please enter the NAME of items your require followed by the STRENGTH, FORM and QUANTITY. e.g ATENOLOL 25mg Tabs x 28
Please tick box to order same as last month
*
Same as last month
Item 1:
*
Please Enter Item name strength and form e.g Atenolol 25mg tabs
Item 2:
*
Item 3:
*
Item 4
*
Item 5
*
Item 6
*
Item 7
*
Item 8
*
If you would like any items from the shop to come with your deliver please enter in the box below. We will contact you if you have provided a telephone number.
*
Please list all the items you would like to come with your delivery.
Would you like to collect your medication or have it delivered?
*
Yes I would like a delivery
No I will call into the pharmacy
Please select ONE option
Submit
MX Services
Dressings and ostomy supplies
Erectile Dysfunction Service
Minor Ailments
Morning after pill
Medicines Use Review
Order My Prescription
Palliative care Pharmacy Lancashire
Passport Photos
Prescription Collection + Delivery
Stop Smoking Service
Read Blog
Travel Clinic
MX Travel Clinic
Hajj and Umrah
Tick borne Encephalitis
Vaccinations
Flu Service
Hep B Vaccination service
Pneumonia Jab
Shingles
Alphega Pharmacy App
Contact Us