To help us provide you with the best possible care, we ask patients to complete a pre-consultation form before attending certain services at Church Lane Pharmacy. These forms allow our healthcare team to review your medical history, understand your needs, and ensure your appointment runs smoothly and efficiently. When you book your appointment the relevant forms are emailed to you but just in case you lost the email or it never arrived you can find the forms below.
Please note: not all services require a form to be completed, if you don’t see your service listed below it means we don’t need you to complete a pre-consultation form.
If you are booking or have booked a travel vaccination from the following list we only need you to complete our Travel Risk Assessment Form. This is required for:
If you have booked a Yellow Fever Vaccination, you will need to complete two pre-consultation forms. Completing these forms in advance ensures we have all the necessary information for your appointment, allowing us to provide a quicker, safer, and more comprehensive service on the day.
For our Period Delay service, we kindly ask that you complete the form below prior to your appointment. The form takes approximately 5–10 minutes to complete. While it is detailed, it ensures we have all the necessary information to provide you with the safest treatment and the best possible advice on the day of your visit.
For our NHS Pharmacy Contraception Service, please complete the form below prior to your appointment. This will take approximately 5–10 minutes and allows our pharmacists to review your medical history and ensure the most suitable and safe contraception options are provided. Completing the form in advance helps us deliver a smooth, efficient, and confidential service on the day of your visit.
For our Ear Wax Removal service, we require you to complete the consent form below before your appointment. This form takes around 5 minutes and ensures we have all the necessary information to safely carry out your treatment. Completing it in advance helps us provide a quicker, safer, and more professional service during your visit.
