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Home > Prescriptions: Rescue pack medication for COPD

Prescriptions: Rescue pack medication for COPD

Please note that urgent temporary issues of a prescription can be obtained from your local pharmacy. 

Please outline below your request for your rescue pack medication. This should not be done if you have current active symptoms. If this is the case do not complete this form and instead call reception for a telephone appointment. Thank you. 

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 316711. We will start to process your form by the next working day but it will take up to 3 working days to complete. Please DO NOT call before 3 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.
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Prescriptions: Rescue pack medication for COPD
If no state 'NO'

1) I confirm that I have a diagnosis of Chronic obstructive pulmonary disease (COPD)

2) I have been issued rescue packs before by the practice in the past

3) I do NOT have a current active infection

If the answer is false. Abandon this form and contact reception.

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Whitnash Medical Centre

110 Coppice Road , Whitnash, Warwickshire, CV31 2LT

  • 01926 316711
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