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Haydon Bridge Pharmacy

Sign Up for Free Collection & Delivery

We will collect the prescription from your Doctors surgery and deliver it to an address of your choice.

Please complete all fields marked with an *

I consent to Haydon Bridge Pharmacy collecting my prescription either in person or electronically.
I authorise Haydon Bridge Pharmacy to deliver my prescription.
I authorise Haydon Bridge Pharmacy to order my prescription if needed.
I have read the electronic prescription service information leaflet.

First Name *
Last Name *
Email Address *
Date of Birth *
Your Address *
Telephone Number *
Doctors Surgery *
Do you have any special instructions (e.g. alternative address or tel.)?
I understand the agreement may be cancelled at any time by either party.

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