Payment and exemption
If you do not pay prescription charges please tell us why (tick the relevant option below).
MY AUTHORISATION AND CONSENT
I understand that my registration with you is subject to Joydens Wood Pharmacy standard terms which i can view at
If I have stated I am exempt from payment, I confirm I am properly entitled to exemption and that if my entitlement changes, I will tell you immediately on 01322 522 711.
I understand that if i do not, you may take appropriate action.
I consent to my prescription:
being collected from my GP Surgery
being from my GP Surgery using the Electronic Prescription Service (EPS) to Joydens Wood Pharmacy
being to delivered to the address stated on this form
my contact details being used for communication purposes only in relation to matters concerning prescripition collection or delivery