Order Your Prescription

We can dispense your prescription after you have filled out the form below.

Please note that Pharmacy Mentor will become your nominated pharmacy should you wish to dispense from us.

    Personal details

    Surgery details

    Prescription details

    Please write down the Name, Strength, Form and Quantity of each medicine you require
    e.g. Atenelol Tablets 25mg x 28. Only order what you need.