Complete the section on the follow page which applies to your medication request.

Before you start

• Your practice will aim to respond to your query within 2 working days.
• If your query is not submitted, no details will be sent to your GP.
• You must be over 16 to use this service, although you may use this service to contact the practice about a person you care for who is under 16.
• You must be registered as a patient with Eden Villa Practice.
• I am resident in, and am currently in, the UK.