Admin: Holiday Medication Letter Request

In the majority of cases you will be able to travel with your medicines abroad with no issues. For certain medications and on certain airlines they may request a letter from your prescriber prior to travel.

As this service is not covered by the NHS, this is charged at £28.50. We will contact you via a text message to let you know the outcome of your request.

It can take up to 5 working days for this request to be completed and we mujst receive payment prior to providing the service. Payment can be made at the surgery by cash or card.

This medication letter will be valid for 12 months, unless changes have been made to your medications.

For more information on travelling abroad with medication follow this link to the NHS website

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 7 working days to complete. Please DO NOT call before 7 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

Admin: Holiday Medication Letter Request

Full Name:

Date of Birth (DD/MM/YYYY):

Mobile Number:

Destination of holiday/trip:

Outbound date of trip:

Return date of trip:

Medications you will be travelling with (Name, Dose, How many times a day)

Duration of Holiday/Trip (days)

I confirm I am happy to be contacted by the surgery (text or call) on the mobile number provided if deemed necessary and that the information given in this form is accurate.

I confirm I am happy to pay £28.50 if this letter request is approved.

Privacy Protection

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.

I consent to my information being used for the purposes described above and wish to submit this online form to Clarendon Lodge Medical Practice • Clarendon Lodge, 16 Clarendon Street, Leamington Spa, Warwickshire, CV32 5SS.

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