Medicines Information Enquiry Form

Healthcare professionals in the South West region of the UK may use this form to submit medicine related enquiries to South West Medicines Information Centre.

If you would like to speak to us directly or your enquiry is urgent, please phone: 0117 342 6655 between 8.45am-5pm Monday to Friday

Please note: * indicates mandatory field

Your Contact Details Your Name*
Work Address*
Work Telephone
Email*
Job description*

Your Enquiry Details Does your enquiry involve a specific patient?
If yes, please provide the following information:

Patient Details Patient identifier: eg initials or practice number
Relevant medical history

Please include if:

Pregnant - How many weeks pregnant?
Breastfeeding - Age of baby and if born full term and healthy
Abnormal kidney function - eGFR or CKD stage
Abnormal liver function - LFTs

All current medication
Your question
Please state your enquiry in a clear and precise manner, providing as much information as possible to enable us to answer your enquiry. Use the categories in the Adapted Quick Question Guide to help identify additional background information we need to answer your enquiry.

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Method of reply

Medicines Information Enquiry Form

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