Clinicheck

Private Medical Care

 
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Approved Private Prescriptions

 

This form must be completed ONLY if your prescription has been approved by our physicians. 

 

Name (forename and surname) *
Address 1 *
Address 2
Town *
County
Country
Postcode *
Contact Number *
Email
Authorisation Code *
Prescription Item *
Total fee quoted for prescription (QPF)

 

Pharmacy/Chemist to collect medications   Deliver to my address above

 

Pharmacy Name (to collect medications) *
Postcode (to collect medications) *
I would like to collect my medications from the pharmacy/chemist above and I agree my debit/credit card to be charged with QPF

 

Security: Please enter the number in the image above into the box below

 

Items marked with * are mandatory

 

 

 

News

The Paydens Group of Pharmacies join Clinicheck's network of medical diagnostic testing.

 

 

 
Clinicheck are pleased to announce the launch of their new web site. Any comments please email us.