Home About Us Services Private Prescriptions ETP Nomination Patient Survey Place An Order Contact Us chel pharmacy Private Prescription Form Full Name Date of Birth Full Address Telephone Mobile Email Doctors Name Surgery Name Surgery Address Please confirm: Please confirm: I would like Chel Pharmacy to contact my doctor to obtain my prescription. OR OR I will contact my doctor myself and ask them to send my prescription to Chel Pharmacy. I agree to Chel Pharmacy sending my prescription to me by courier or post. I understand that this may take 24-48 hours to reach me if stock is not immediately available. Are you: Are you: Patient Authorised Representative Representatives Full Name Relationship to patient Submit