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Ask Your Pharmacist / Registration Form

Please enter your details below and we will respond to your request A.S.A.P

All forms submitted from this website are completely confidential and secure.

Title:

Mr: Mrs: Miss: Ms: Other:

Full Name:

Address:

Telephone Number:

Home Number:

Business Number:

Mobile Number:

Email Address:

Date of Birth:

   

Medical Conditions:

Allergies:

List of Medications:

Preferred time of delivery
(Between 9am and 5pm weekdays)

Queries:

   
Only Fill in relevant Section for Prescription Type:

NHS Prescription:

Paying:

Exempt Status:

Exemption Card No:

Expiry Date:

   
Authorise:
 
Please tick this box in order to authorize Gateway Chemist to collect your prescriptions on your behalf, and to ask for your repeat medication.
   

Private Prescription:

Name Of Medicine:

Quantity Needed:

Do you need our doctor to prescribe?

 
If out of Finchley Central, Please choose you preferred method of postage (extra charge may be incurred)

Postage:

Ordinary Parcel Post: Fedex:

 

 

Foreign Prescription:

Name Of Medicine:
Quantity Needed:

 

 

Over The Counter Medication:
Name Of Medicine:
Quantity Needed:

The Owner/Superintendent pharmacist: Mr. S. (Jack) Hikmet

Royal Pharmaceutical Society of Great Britain ( RPSGB) Registration number: 71766

Address:

Gateway Chemist
334 Regents Park Road
Finchley Central
London N3 2LN
UK

Opening Times:

Monday - Wednesday 9:00am - 6:30pm
Thursday - Friday 9:00am - 6:00pm
Saturday - 10:00am - 5:00pm
Sunday - Closed

RPSGB premises registration No.: 1040332

Mailings in UK: FREEPOST GATEWAY CHEMIST

E-mail: info@gatewaychemist.com

Sales: sales@gatewaychemist.com

Enquiries: question@gatewaychemist.com

Telephone: 0208 346 4530

Dispensary: 02083710046

Fax: 02083710429

Complaint procedure: All complaints should be put in writing and addressed to Mr. Jack Hikmet , on the above address.

The registration number of the Pharmacist and pharmacy can be checked with the RPSGB on:

Royal Pharmaceutical Society of Great Britain
1 Lambeth High Street
London SE1 7JN
Tel 020 7735 9141
Fax 020 7735 7629
E-mail: enquiries@rpsgb.org


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