Redcar Prescription Ordering Form
Title
E-Mail Address
Please Select
Mr
Mrs
Ms
Miss
Master
First Name
Surname
Address
Town
Please Select
Marske
New Marske
Redcar
Saltburn
Stokesley
Great Ayton
Postcode
Telephone Number
(eg: 0164248565)
Surgery
Please Select
Bentley Medical Practice (Gowda, Carrasco, Tahmassebi, Schmidt)
Coatham Surgery, Redcar. (Stocking, Lyle, Summers, Raeburn)
Green House Surgery (Davidson, Barker, Holdsworth, Woolder, Moore, Hopkirk, Cowser)
Health Centre Gt Ayton (Smith, Blacklidge, Green, Myers, Jackson)
Health Centre Stokesley (Park, Krishnamoorthy(Palani), Duggleby, Tawse, Amann, Parker, Francis)
Huntcliffe Surgery (Milner, Fish, Sutton, Brownlee)
Lagan Surgery, Redcar. (Wilson, Sutcliffe)
Marske Medical Centre (Yates, Redolat, Gjertson, Zijlmans, Severn, Mahmood)
Park Avenue Surgery, Redcar. (Murphy, Tahmassebi)
Rainbow Surgery (Islam)
Ravenscar Surgery (Boyd, Oostdijk)
Saltscar Surgery, Redcar. (O'Flanagan, Ingledew, Smith, Rashid)
Zetland Medical Centre (Saha, Hill, Gossow, Fox, Johnson, Grainger)
Prescription service required
Collection Only
Collect & Deliver
Order & Collect
Order, Collect & Deliver
For collection only and collect and deliver :
Please give the date the prescription will be ready at the doctors:
How many items have you ordered:
For ordering please complete the table below:
Drug Name
Strength
Form
Example:Aspirin Dispersible
75 mg
Tablets
I
f you have any special requests or questions please contact the branch.
