Curaleaf Pharmacy Consent Form

To minimise any disruption to you receiving your medicine while we complete our corporate restructure, we would like to propose a temporary change in which Pharmacy dispenses your medicine on our behalf. We’ve been in discussion with Curaleaf Pharmacy who will happily dispense this prescription to you to ensure no disruption to your healthcare plan. This is a temporary measure which will be rectified by the time your next prescription is due, with medicine dispensing reverting back to Dispensary Green. Please confirm that you are happy for us to send your prescription to Curaleaf Pharmacy by completing this form.

MM slash DD slash YYYY
I consent for my next prescription to be sent to Rokshaw .(Required)