Important updates

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info@yourpharmacy.uk

Phone Number

0114 400 0181

Our Location

26 Greenhill Main Road

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Hayfever and Allergy

Important updates

Home
Weight Loss
Services
Men’s Health
Women’s Health
Travel Clinic
Skin Care
Hayfever and Allergy

Next Strength

Next Strength

"*" indicates required fields

Step 1 of 5

20%

Your Name*

First Last

Phone*

Email*

Date*

Day

Month

Year

Gender*

Street Address*

City*

County / State / Region

Post Code*

Country*

What is your weight? (include units)*

What is your height? (include units)*

What is your current treatment plan?*

Have you experienced any side effects/ adverse reactions?*

Yes

No

Have you noticed any health/ lifestyle improvements since starting the treatment?*

Additional comments or concerns?*

Are you experiencing any difficulty in administrating the treatment (e.g. injection/ dosing schedule)?*

Next Steps

Are you comfortable on the dose you are currently on?*

Do you want to increase dose or stay the same?*

Patient's Agreement

Do you agree to the following statement - I understand and have answered the questions above honestly*

Yes

No

Do you agree to the following statement - I will read the patient information leaflet provided with the medicine specifically the side effects and dosages.*

Yes

No

Do you agree to the following statement - I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care.*

Yes

No

Availability

When would be ideal for us to contact you for a phone call? (For additional questions and appointment)*

Email

This field is for validation purposes and should be left unchanged.

Pharmacy Info

Company Registration: 14116972
Premises GPhC Number: 9012029
Superintendent: Adil Amini (2083818)

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Contact

26 Greenhill Main Road, Sheffield, South Yorkshire, S8 7RD
0114 400 0181
Info@yourpharmacy.uk

Opening Hours

Mon – Fri: 09:00 to 17:00
Saturday: Closed
Sunday: Closed

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