Order Medication Return to Kensington Park Medical Centre Homepage Company OptionalThis field is for validation purposes and should be left unchanged.Title Mr Mrs Mx Miss Ms Dr Other First NamesSurnameDate of Birth Day Month Year Address Street Address Address Line 2 City Postcode Phone NumberConfirm Phone NumberEmail Address Enter Email Confirm Email Enter each medication and strength on your prescriptionMedicationMedicationStrength Add RemoveAdditional Notes OptionalPlease attach any relevant documentation relating to your request, for example a clinic letter which details why you are requesting the medication.File Optional Drop files here or Select files Max. file size: 1 GB.