Please complete the details below and then press Send Ordered By * Contact Email * Your Pharmacy Name * Street * Town/City * Post Code * Telephone * Street * Reg No of Pharmacist * Patient Name/Order Ref * Prescription Details and Quantity Please include special instuctions if necessary. Please provide Prescriber name and Post Code to enable pre-population of PCT submission form. * * denotes required fields If you prefer you can download an order form, fill it in and fax it to us. You can also place your order by telephone on 0800 917 2055: Click to download order form. DOWNLOAD ORDER FORM