EHCO rder Form

							             EHC PHARMACY SCHEME ORDER FORM
You can order by:     phone:        01604 362950 / 362956
                      email:        hpresources@northants.nhs.uk
                      post:         Health Promotion Resource Unit
                                    Booth Meadow House
                                    Museum Way, Riverside Park
                                    Northampton NN3 9HW

Contact Name:
Pharmacy Name & Postcode:
Pharmacy Phone Number:
*Nominated GP Practice:
(Name & Address)

                                                                    Date: 04/11/2012


  *Please Ensure That You Have Made Arrangements With The Nominated Practice.

Collect from HPRU, Booth Meadow House
OR
Deliver to (please tick):

Address above (Nominated GP Practice ONLY)
Willowbrook Health Centre, Corby                  NCC Library, Daventry
NCC Library, Rushden                              NCC Library, Thrapston
NCC Library, Towcester                            Isebrook Library, Wellingborough
Library, Kettering General Hospital               NCC Library, Hunsbury, Northampton
NCC Central Library, Northampton

                                                  Number of boxes/ items required
Regular Pasante condoms (144 per box)
FPA Your Guide to Emergency Contraception
leaflets (in multiples of 20)
FPA Your Guide to Contraception leaflets
(in multiples of 20)
FPA Love Stings booklets
(in multiples of 20)

                                                  Number required
EHC Flyers/Posters                                A5            A4                A3
EHC Window stickers

Please allow two weeks for delivery, or ask HPRU staff for urgent requirements.

From April 1st 2009 all consultations should be entered onto the Webstar Service PACT
online system, to ensure prompt payment.

                    To find out more, visit: www.library.northants.nhs.uk