Order prescriptions online Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Title *Full name *FirstLastDate of birth * quantity strength 1 Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeEmail address *Home phone numberMobile phone numberYour GP *— Select Choice —Dr Catherine DixonDr Gail SandersonDr Matthew TravisDr Kathryn McCreadyDr Peta LandPreferred collection point *CommentsMedication 1 name *Medication 1 strength *Medication 1 quantity *Medication 2 nameMedication 2 strengthMedication 2 quantityMedication 3 nameMedication 3 strengthMedication 3 quantityMedication 4 nameMedication 4 strengthMedication 4 quantityPrivacy protection *I consent to my information being used for the purposes described below and wish to submit this online form to Stockwell Road Surgery, Knaresborough, 21 Stockwell Road, Knaresborough, North Yorkshire, HG5 0JY. Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy. This information is not shared with any third party organisations. This information is retained for up to 28 days. Learn more about our Privacy Policy and Terms of Use in our policies section. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation. Submit