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

Registration

Registration

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.

Contact us:

*I agree to the Terms and Conditions

Registering ...
× Thank you for completing this form. If you would like a health check, please ask for an appointment at reception.