prescription request form

Please ensure you include both the name and strength of the medication your require (eg. "Paracetamol 500mg").

You can collect the prescription direct from our Reception (either at Canalside or Crossflatts - let us know which) or we can send the prescription to one of the local pharmacies for processing.

After submission, you should receive an e-mail from us confirming receipt of your request. If you don't, check your "spam" and "junk" folders before contacting us by telephone.

Please allow 2 working days for your request to be processed.

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forename *

surname *

date of birth *

E-mail address: *

postcode *

Boots - Canalside

Boots - Main Street

Dalesway Pharmacy

Crossflatts Pharmacy

Knights Pharmacy (Eldwick)

Cottingley Pharmacy

I require the following medication (name & strength): *

Captcha (spam protection code): *

I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

Note: Fields marked with * are required

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