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NHS Shropshire, Telford and Wrekin Prescription Ordering Direct (POD) Request
Are you completing this form on behalf of:
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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
*
Please select…
Albrighton Medical Practice
Belvidere Medical Practice
Bridgnorth Medical Practice
Broseley Medical Centre
Brown Clee Medical Practice
Cambrian Medical Centre
Caxton Surgery
Charlton Medical Centre
Churchmere Medical Group (formerly Bridgewater, Claypit Street and Ellesmere)
Church Stretton Medical Practice
Claremont Bank Surgery
Cleobury Mortimer Medical Centre
Court Street Medical Practice
Dawley Medical Practice
Donnington Medical Practice
Hollinswood and Priorslee Medical Practice
Ironbridge Medical Practice
Linden Hall Surgery
Ludlow – Portcullis
Marden Medical Practice
Marysville Medical Practice
Mytton Oak Medical Practice
Plas Ffynnon Medical Centre
Radbrook Green Surgery
Riverside Medical Practice
Severn Fields Medical Practice
Shawbirch Medical Practice
Shawbury Medical Practice
Shifnal and Priorslee Medical Practice
South Hermitage Surgery
Station Drive Surgery
Stirchley Medical Practice
Teldoc
Wellington Medical Practice
Wellington Road Medical Practice (Newport)
Wem and Prees Medical Practice
Much Wenlock and Cressage Medical 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 any 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.
