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 *
Postcode *
Contact Number *
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





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.