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Quick Pharmacy Access Form
Use this form to let us know what you need today. The use of this form will speed up our response times, thank you for helping. Your information is processed securely in line with NHS‑GDPR standards.
What would you like to do today?
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Collecting an NHS Prescription (Existing Patient)
Collecting an NHS Prescription (First Time Using Our Services)
Collecting a Private Prescription
Attending an Appointment with Pharmacist‑Led Clinic
Attending an Appointment with a Booked Therapist
Ordering a Prescription Request
Checking Stock Availability
Which Pharmacy are you at/ do you use?
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405 Croydon Road, Local to Beckenham Hospital
70 High Street, on the Hill, towards Beckenham Junction
Your Name
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Your Full Name is Required, including your title
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Your Date of Birth
*
-
Day
-
Month
Year
Date
I confirm that my Date of Birth is correct. I understand that providing an incorrect DOB may delay processing or resolution.
*
YES
Your Email
*
NHS number (Look on NHS App or on your repeat form)
The Prescripiton was issued
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Today
Eariler than Today
I am collecting an owed item, that was part dispensed earlier
Medicine Required (Name/ Strength and Form)
Select the online doctor or clinic that issued your private prescription
*
Please Select
Local GP Paper Private Prescription
HealthHero/ MyClinic
eMed UK
Push Doctor
Medicspot
WedDoc UK
iGP
Livi (Private GP)
MD Direct
Other (please specify)
If "Other", please tell us the name of the online doctor or clinic
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Enter the reference number exactly as shown in your online doctor’s portal or email.
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Time of Scheduled Appointment
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Hour Minutes
AM
PM
AM/PM Option
Pharmacist Led Services
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Pharmacy First NHS Service
NHS Blood Pressure Check and 24-hour Ambulatory Check
NHS Contraceptive Services
Private Weight Loss Clinic
Practitioner Led Clinic Name
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CBT- Talking Therapy (Mondays)
Ear Microsuction (Tuesday and Saturday)
Podiatry and Foot Care (Wednesday)
Trichology, Scalp and Hair Care (Thursday)
Nutritionist, and Weigt Management (Friday)
List of Medicines Required
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I consent to Beckenham Pharmacy processing my information in accordance with NHS‑GDPR standards.
*
I consent to Beckenham Pharmacy processing my information in accordance with NHS‑GDPR standards.
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