• 5 Castle Hill Parade, West Ealing, London W13 8JP.



Before you can purchase any medication you must complete the following simple questionnaire.

1. Personal details

Emergency Contact

2. Allergies

3. Present Illnesses, (Please Tick)

Please Tick the Box to state that the details you have entered on this form are correct and you consent for this information to be entered on your medication records with Medic plus Clinic.

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*I agree to the Terms and Conditions

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