Arc Pharmacy

REGISTRATION FORM
Please complete this form as fully as possible if you wish to register for either the Collection Service or the Collection & Delivery Service* operated by ARC Pharmacy.
Once completed click on the SUBMIT button to send us your details.
*All deliveries are at the discretion of the pharmacist.

* Required Fields

Name:

Address 1:

Address 2:

Postcode:

Date of Birth:

DD	MM	YYYY
			*

Email:

Telephone No:

(Your telephone number will only be used if there is a problem with your prescription.)

I give my permission to ARC Pharmacy to collect my prescription:

Yes:

No:

Doctors Name:

Surgery:

Prescription Type:

Additional Comments:

Date Prescription will be ready for collection:

Date Prescription will be collected from Arc:

(Please note that the delivery service is at the discretion of the pharmacist.)

Click Here to view our opening Times.
Now open until 8PM on Mondays at our Portholme Road Branch.

Have difficulty collecting your prescription?

Haven’t got time to wait for your prescription to be dispensed?

Then why not take advantage of our free prescription collection, repeat prescription collection and delivery* services.

Click here for details on Collection and Delivery services.

Chesty cough?

Bad cold?

Why not relieve your symptoms with our famous Special Bronchial Mixture made on the premises.

Ask in store for advice.

Going on holiday…unsure of which health precautions to take?

Come in and visit us at ARC Pharmacy for advice.

Click here for your personal holiday checklist.