Pharmaself24 Consent Form

Please fill in the consent form below with your details to allow us to dispense your items using the Pharmaself24 machine. Please note that we cannot dispense items normally kept in the fridge or controlled drugs from the PS24. If you have these on you repeat prescriptions, please continue to collect your medication from the surgery.

Last Updated: 12/08/2021

Personal Details






Check and confirm your details

Please check your details are correct before submitting this form. Once we have checked your details, we will change your preferred location for dispensing to Dacre Banks surgery and will use the PS24 machine for collection of your medication unless you tell us otherwise.