Request a prescription

Typically today’s date
Your mobile or telephone number
This can be found on a previous hospital letter
How often you take the drug
A GnRHa (eg syneral, decapeptly, zoladex, prastap) is not a licenced contraceptive—if you are requesting a drug from this group, you must confirm that you not currently pregnant and using contraception
Complete only if you ticked the third option above
List all known drug allergies—if none, write ‘none’
Please provide a blood pressure reading taken within the last two months—this can be done at home, your GP surgery or a pharmacy
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