Shropshire, Telford and Wrekin POD

NHS Shropshire, Telford and Wrekin Prescription Ordering Direct (POD) Request

Using our webform creates a secure link to protect your data. When we reply to your email via our NHS email the replies are sent back to you via a secure platform called Egress. This is controlled by NHS mail and will require you to create a login so that you are able to see our replies. This is an extra step that you will need to do once. Prescription Ordering Direct do not have any control over Egress.

Are you completing this form on behalf of:*
- Yourself
- Someone else (e.g. a child or dependent)
Patient First Name*
Patient Last Name*
Patient Date of Birth*
DD slash MM slash YYYY
First line of Home Address*
Your First Name*
Your Last Name*
Relationship to Patient*
Contact Phone Number*
Contact Email Address*
About Your Request
Registered Practice*
Chosen Pharmacy Name*
Chosen Pharmacy Address*
Not sure where the closest pharmacy is? Use the NHS Find a Pharmacy tool.
Repeat Medication Required
If the strength or quantity field listed below is not applicable, please specify using ‘N/A’. If you are ordering your medication and you have more than 7 days supply left, please explain why you are requesting your medication early in the additional comments box.
Additional Comments
Repeat Medication Required*
Item Description Strength Quantity

This service is for repeat medication only. Requests cannot be processed for urgent prescriptions.
Consent
Consent*
I consent to the NHS POD service accessing my full medical record in order to process my repeat prescription.*
Please be aware that our replies are only read via a secure platform called Egress, an account will need to be created only once.
Replies to your enquiry may appear in your junk inbox.

You are able to withdraw your consent at any point by contacting your medical practice directly.

Item Description	Strength	Quantity

NHS Shropshire, Telford and Wrekin Prescription Ordering Direct (POD) Request

About Your Request

Repeat Medication Required

Consent