Self Medicating Waste Collection Request

Average response time

8,564.32 minutes

Local Authority


Issue Type

Full Name


Address Line 1


Address Line 2


Postcode


Telephone


Email Address


GP Name


Comments/Special requirement/Access instructions


You must tick the box to give us a permission to store the details that you have given us. The Data Protection Act 1998 requires us to ask you to do this so that we can ensure that the data you have given us is kept confidential and will not be shared with any unauthorised parties.