New services now available at VSM

Blocked ears? Blood pressure test? Removing a skin tag? Urinary infection?
Our trained staff can provide services that are no longer available on the NHS.
A wide range of free NHS services are also available.

You have selected PARK ROAD SURGERY

IMPORTANT:

Your prescription will be collected by VSM Pharmacy.  It is best to place your repeat prescription’s request at least 5 working days before you run out of medication. This allows time for your GP to authorise the prescription(s) and for our pharmacy team to dispense your medication.

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Patient Details

Name*
Date of Birth*

Contact Details

Please Note: To lessen any delays in processing your prescription please enter into the box below which doctor you usually see regarding this condition or medication, so that the receptionist knows which doctor may be best able to check and sign your prescription.

Medication Information

NOTE: Please enter the drug name(s) and strength(s) as they appear on the drug label or your repeat prescription form. Please do not specify the quantity. Thank you. If you wish to add more items, please click the "+" button on the right of the text field entitled "Name & Strength of Medication".
Name & Strength of Medication:*
Please enter the name & strength of the medication as printed on the dispensing label. Click on the + sign on the right side of the field to add a new medication to your order.

Patient Instructions

Please use the freetext box below for surgery or pharmacy notifications specific to your prescription - e.g. to explain that you are ordering early or need extra quantity because you are going on holiday.
If you need to order more items than there are lines available, please submit a new form for the additional items. As soon as you press "Submit" below, your prescription request will be e-mailed to VSM Pharmacy and your surgery. Please check your entries above before you proceed. All the information collected through this form is only provided to your surgery and VSM Pharmacy and used to provide the repeat prescription service. This information is not shared with any other third party.

Please enter your details and we'll get back to you as soon as we have the new tests in stock.

  • Hidden
  • This can be found on the automated email you received at the time of purchasing the test. We just need the 4 numbers.
  • For Fit-to-Fly tests, that is the day you leave the UK; for the other tests, that is the day you arrive in the UK.
    DD slash MM slash YYYY
  • That is the time when you take your ferry, or board your flight or train.
    :
  • For fit-to-fly test, please indicate the country you are flying to. For all other tests, please indicate the country you are travelling from.

Please enter your details and we'll get back to you.

"*" indicates required fields

Name*
This field is for validation purposes and should be left unchanged.