Pharmacy Enquiry Form

Medicines enquiries for Healthcare Professionals

Healthcare professionals may use this form to submit medication enquiries to Southend Hospital Pharmacy

Enquiries will only be answered between 9am and 5pm Monday to Friday and we will respond in 5 working days.
If your query is urgent then please contact the pharmacy on 01702 385458
Please be aware that we are only able to answer questions relating to specific medication related issues and not clinical issues regarding diagnosis.

First Name:

Surname:

Job role:

Organisation/Place of work (and department where applicable):

How would you like to receive your reply?

Email Telephone

Telephone number:

Email address:

Does your question relate to the following?

Outpatient prescription Discharge Prescription Another Medication issue

Does your question involve a specific patient?

Yes No

Patient identifiers not known

Patient's initials:

NHS number (if known):

Hospital number:

Date of birth:

Your question:

When do you need an answer?

Please note you may be contacted if we cannot meet this deadline.
Please give a specific date - do not use ASAP.

Enter captcha:

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This form will send the personal information you have entered to us via email. This will be treated in the strictest confidence. We will use the personal information to respond to your enquiry. We will process your data in accordance with the Data Protection Act 1998.