Prescription Question

You can use the form below to ask the Practice a question regarding your medication, such as:

• When you should take it and what to do if you miss a dose.
• What the possible side effects are, and what to do if they occur.

Also please see our Prescription Information Page.

Prescription Question

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Mobile Phone Number (preferable):

Home Phone Number:

Email Address: *

If you don't provide an email address we won't be able to respond to you by email

Named GP (if known):

What is your prescription question?

*

I confirm that my enquiry does not require an urgent response

I confirm I am a registered patient at Montgomery House Surgery