Ask a question about your medication

Use the form below to ask a question about your medication.

Name(Required)

First Last

Date of birth(Required)

NHS number (if known)

Email(Required)

Enter Email Confirm Email

Address(Required)

Postcode(Required)

Daytime telephone number(Required)

Mobile telephone number

Named GP (if known)

What is your medication query?(Required)

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help OR urgent medication orders or requests