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Using this form results in the information you enter being sent across the internet. We take reasonable steps to ensure the security of your information. Look for the padlock in the address bar, whoch confirms that the connection to our server is secure.

The server sends an email to our administration team, who then order the prescriptions you need. The information you submit in your request may be retained on our computers and the Northern Ireland Health & Social Care email server.

For more information about how we use your data to provide you with healthcare services, please see our privacy notice. Use of this form confirms your acceptance of the information being used in this way.