Tam's Brig Surgery -

Welcome to the Tam's Brig Surgery Website

Choose font size: A A A High Contrast

Patient One Patient Two
Patient Three Patient Four

If you check the 'Save my details' and/or the 'Save my medicines' boxes when you submit this form it uses cookies to store your personal details for your next visit.

If more than one person uses this form to request their prescriptions please select a radio button to save each person's details. Next time you visit the page click on your radio button to retrieve your details.

A cookie, also known as a web cookie, browser cookie, and HTTP cookie, is a piece of text stored by a user's web browser.

Please be aware that if you delete your cookies you will have to type your information in again next time.

Also cookies are saved to the computer that you are on only.

You can store a maximum of four people's details by using the radio buttons at the top of the form.

* - fields required

Forename: *
Middle Name:
Surname: *
Date of Birth: Format: dd/mm/yyyy *
House name/number: *
Street:
Town: *
City:
County:
Postcode: *
Telephone: *
Mobile Number:
Email: *
Repeat Email: *

Medication:

Strength:

Dose:

Required:

If you require more than 6 items please click here

Additional notes:

Doctor:

Pick up:
*

Enter the characters as seen on the image above (case insensitive):

Code: