PharmaSelf 24 Form

The Pharmaself24 (PS24) is a safe & secure automated prescription collection point from which repeat prescriptions or pre-paid pharmacy medicines can be quickly & easily collected from 6am to 10pm.

(Please note the medicines that cannot be collected)

Pre-paid Pharmacy Only (P) medicines can only be collected from it after telephone consultation with one of our pharmacists.

I consent to the following:

  • Bannside Pharmacy collecting prescriptions on my behalf from my GP practice
  • Bannside Pharmacy requesting prescriptions to be ordered from my GP practice on my behalf on some occasions
  • Receiving information via the PS24 App, or by SMS text message
  • Engaging with my pharmacist in an annual Medicine Use Review – or any other pharmacy service – if I have a medical condition that makes me eligible for such a service e.g. Type 1 or Type 2 Diabetes or Respiratory conditions. I am free to withdraw my consent for this at any time.
  • Engaging with my pharmacist at any other time that they – or my GP – deems appropriate for the benefit of my health & wellbeing. This is recommended at least twice a year.
  • I understand that any information gathered for me to use the PS24 will be kept confidential and secure, as outlined in the separate GDPR Privacy Notice which I have received and read.

I have read and understood all the above information about the PS24 and I am able to make an informed decision about using it to collect my repeat prescriptions. I wish to collect my prescriptions from the PS24 under the terms and conditions stated.

Consent Form

PharmaSelf 24