Please complete this form if you would like to arrange a face-to-face consultation with your local pharmacist. Once the form is complete please call the pharmacy that you have selected to arrange the best time to visit. This should be done on the same day you complete this form. 

*Please note this service is only in operation based on pharmacy opening hours

Birk & Nagra 170 Rugby Rd Milverton: 01926426863

Boots the Chemist 31 The Parade: 01926 424945

Boots the Chemist 37-39 Oxford St: 01926 887268

Hb Dunn Chemist 31-33 Oxford St: 01926 424796

Lillington Pharmacy 100 Cubbington Rd: 01926 426124

Lloyds Pharmacy 51 Clarendon Street: 01926 336568

Lloyds Pharmacy 51 Crown Way: 01926 423582

Lloyds Pharmacy Shire Retail Park: 01926 881701

Superdrug Pharmacy 88-90 The Parade: 01926 450953 

Adults

Please do NOT complete this form and instead contact us or 111 out of hours if you have any of the symptoms below:

• your face or the area around your eye is affected
• you have a weakened immune system – for example, because of chemotherapy or diabetes

Please call 999 if you have any of the symptoms listed below. These symptoms indicate sepsis which is a life-threatening condition. 

• a very high temperature, or you feel hot and shivery
• your symptoms are rapidly getting worse – this could be a sign of something more serious like the rare condition necrotising fasciitis
• a fast heartbeat or fast breathing
• New rash which does not fade with pressure (Non-blanching rash)
• purple patches on the skin
• feeling dizzy or faint
• confusion or disorientation
• cold, clammy, pale skin
• unresponsiveness or loss of consciousness

Children

Please do NOT complete this form If your baby or child is experiencing any of the following symptoms alongside a rash. Instead call NHS 111 urgently and a trained medical advisor can assess the symptoms over the phone and advise you on the next steps to take:

• becoming floppy, unresponsive or stiff with jerky movements
• becoming irritable and not wanting to be held
• unusual crying
• vomiting and refusing feeds
• pale and blotchy skin
• loss of appetite
• staring expression
• very sleepy or drowsy and not wanting to wake up
• fever (high temperature)
• swelling in a baby’s soft spot of their head
• chest pain or difficulty breathing 
• signs of dehydration - e.g. inability to urinate (or fewer wet nappies), drowsiness and cold hands and feet
• sensitivity to light
• severe headache
• severe muscle pain
• convulsion or seizures.

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