Preferred Prescription Pick-up Form

Preferred Pharmacy Form

Please select your preferred option for prescription pick-up from the list below - these are the pharmacies that currently collect from the surgery. We will update your record with your choice.

Name *

Date of Birth *

Phone Number *

Email address *

Preferred prescription pick-up? *

Ferryburn Pharmacy (collect daily)

Queensferry Pharmacy (collect daily)

Well Pharmacy, Kirkliston (collect Tuesday & Thursday)

Omni Pharmacy, Queensferry Road (collect Tuesday & Friday)

Barnton Pharmacy, Whitehouse Road (collect Tuesday & Friday)

Boots The Gyle (collect Wednesday & Friday)

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL AND OTHER PERSONAL INFORMATION. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

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Page last reviewed: 07 December 2023
Page created: 09 September 2021

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Preferred Prescription Pick-up Form

Preferred Prescription Pick-up Form

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