Emergency Line: 0207 377 0727
Email: info@letterboxpharmacy.com / Pharmacy.flf08@nhs.net
Mon - Fri: 9:00 - 18:00 Sat: 09:00 - 13:00

Appointment

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****FREE National NHS Prescription Delivery**** FREE Private Prescription Delivery****Pharmacy First Service National Service ****

Your health questions

Step 1

Q 1: First Name:

Q 2: Surname:

Q 3: Date of Birth:

Q 4: Registered Address (incl. postcode):

Q 5: NHS number (if known - If not known write ''not Known'')

Q 6: To be responsible clinician and to provide the service safely, we will need to access your medical record. Do you allow us to view your NHS medical record (Summary Care Record) and or contact your GP Surgery (if needed) to view your current medical status?

Yes

Unfortunately we wouldn't be able to continue with this consultation - Please see your GP

Q 7: If this is request is part of the FREE NHS Contraceptive service (Tier 1), your information will safely shared with: • NHS England as part of the service monitoring and evaluation; and • The NHSBSA and NHS England for the purpose of contract management and post-payment verification (PPV).

Yes - I am happy for my information to be shared to get this FREE service

No - I am not requesting the FREE service as this is a private consultation

Q 8: To provide this service safely and part of our Governance, we will be informing your GP of this consultation and share information. Do you consent us to provide this service?

Yes

Unfortunately we wouldn't be able to continue with this consultation - Please see your GP

Q 9: Although you have completed this consultation, we will will be contacting you to confirm some details and give you the opportunity to ask or discuss any points you may have. Which mode of communication would you prefer?

Telephone consultation

Video Consultation

I will come in person to the pharmacy

Q 10: How did you hear about this service? Tick which applies:

GP surgery sign posted me to you

Online search

NHS website

Other

Q 11: Which of the following contraceptive service are you needing:

Initiating

starting new contraceptive pill - FREE NHS

Continuation of Combined Contraceptive Pill (COP) - FREE NHS

Continuation of Progesterone Only Pill (POP) - FREE NHS

Continuation of Combined Contraceptive Pill (COP) - Private Chargeable

Continuation of Progesterone Only Pill (POP) - Private Chargeable

Not sure - would like to discuss with Pharmacist

Q 12: Have you previously had a supply of your contraceptive pill from your general practice, sexual health clinic or a pharmacy?

Yes

Q 13: Are you wanting to change your current contraceptive pill?

Yes

Q 14: Have you missed any pills at any point or had a gap of any duration since your last supply?

Yes

Q 15: Have you had any problems with or side effects from your contraceptive pill?

Yes

not sure

Q 16: Are you taking any other prescribed medication? (We will confirm names against your medical record - summary care record)

Yes

Q 17: Are you taking any over the counter medicines or herbal products?

Yes

Q 18: Have you had your blood pressure checked within the last three months?

Yes

Q 19: What is your Blood pressure range (Our clinician will call to confirm the most current reading)

Low (below 90/60)

Normal (between 90/60 ad 140/90)

High (above 140/90)

Q 20: What is your biological sex at birth

Male

Female

Unfortunately we wouldn't be able to continue with this consultation - Please see your GP

Q 21: Are you pregnant, or might you be pregnant?

Yes

Unfortunately we wouldn't be able to continue with this consultation - Please see your GP

Q 22: Do you have long periods of immobility?*

Yes

''Delivering Pharmacy Care to you directly''

Prescriber

Prescriber: Prescriber
GPHC Number: GPHC Number
Tel: 0207 377 0727
Details: Details
Company Name: Company Name
Registered Address: Registered Address

Emergency Supply +

The Team

GPHC Registration No: 9012021
Pharmacist Owner: XRP Health Ltd
Superintendent Pharmacist: Girish Patel
Registration No: 2025710

Pharmacy Details

Address: 20 Spelman Street, E1 5LQ
Telephone No: 0207 377 0727
Email: info@letterboxpharmacy.com