Alcohol treatment assessment We need to confirm your details to verify your prescription and complete your order. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *Date of Birth *Email *Mobile Number *Medication Prescribed *Select MedicationNaltrexoneNalmefeneDo you have a valid prescription? *YesNoPlease upload prescription below Drag & Drop Files, Choose Files to Upload Please upload a clear image of your original prescription document for validation. This will help expedite the processing of your prescription request and ensure accuracy.You cannot obtain alcohol dependency medication without a valid prescription. Please arrange a consultation with a licensed prescriber to receive a prescription before proceeding with treatment. (Consultations are currently not provided by Drugs4Delivery.) If you have an NHS prescripiton, please provide the token code (this is found on the right hand-side of your prescription)Do you have a recent liver function test? *YesNoPlease upload liver function test below Drag & Drop Files, Choose Files to Upload Please upload a clear image of your liver function test for validation. This will help expedite the processing of your prescription request and ensure accuracy.We can provide an initial supply of 28 tablets. Once we receive your liver function test results (dated within the last 6 months), we can dispense the remaining 140 tablets. Are you taking any medication? *YesNoPlease list names and dosages of medication you are taking *Do you have any allergies? *YesNoPlease list any allergies you have *How much do you drink every week? *How often do you drink? *What do you drink? *Please provide a short background of your drinking *Additional NotesCUSTOMER NOTES: Please provide any additional information regarding your medication, delivery preferences, or other important details.I agree to the Terms & Conditions and Privacy Policy *I agreePlease read these Terms and Conditions carefully before using our website drugs4delivery.com, associated applications, and services operated by Drugs4Delivery. 1. Acceptance of Terms By accessing and using our services, you agree to be bound by these Terms and Conditions, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. If you do not agree with any of these terms, you are prohibited from using or accessing this site. 2. Privacy Your privacy is very important to us. Our Privacy Policy, which also governs your visit to our site, can help you understand how we collect and use your personal information. Please read it here: Privacy Policy. 3. Use License Permission is granted to temporarily download one copy of the materials (information or software) on Drugs4Delivery’s website for personal, non-commercial transitory viewing only. This is the grant of a license, not a transfer of title, and under this license, you may not: Modify or copy the materials; Use the materials for any commercial purpose, or for any public display (commercial or non-commercial); Attempt to decompile or reverse engineer any software contained on Drugs4Delivery’s website; Remove any copyright or other proprietary notations from the materials; or Transfer the materials to another person or “mirror” the materials on any other server. 4. Disclaimer The materials on Drugs4Delivery’s website are provided on an ‘as is’ basis. Drugs4Delivery makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties including, without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights. 5. Limitations In no event shall Drugs4Delivery or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use or inability to use the materials on Drugs4Delivery’s website, even if Drugs4Delivery or a Drugs4Delivery authorized representative has been notified orally or in writing of the possibility of such damage. 6. Accuracy of Materials The materials appearing on Drugs4Delivery’s website could include technical, typographical, or photographic errors. Drugs4Delivery does not warrant that any of the materials on its website are accurate, complete or current. Drugs4Delivery may make changes to the materials contained on its website at any time without notice. However, Drugs4Delivery does not make any commitment to update the materials. 7. Links Drugs4Delivery has not reviewed all of the sites linked to its website and is not responsible for the contents of any such linked site. The inclusion of any link does not imply endorsement by Drugs4Delivery of the site. Use of any such linked website is at the user’s own risk. 8. Modifications Drugs4Delivery may revise these terms of service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of these Terms and Conditions. 9. Governing Law These terms and conditions are governed by and construed in accordance with the laws of [Jurisdiction] and you irrevocably submit to the exclusive jurisdiction of the courts in that location. 10. Contact Us If you have any questions or concerns about these Terms and Conditions, please contact us by e‑mail at info@drugs4delivery.com or phone at 01472 241990. We are committed to protecting and respecting your privacy. This Privacy Policy outlines how we handle, store, and protect your personal data when you use our website drugs4delivery.com, associated applications, and services. Information We Collect We may collect and process the following data about you: Personal Information: Your name, address, email address, telephone number, and other contact details. Health Information: Prescription details, medical history, and other health-related information necessary for us to provide you with our services. Transaction Data: Details about payments to and from you and other details of products and services you have purchased from us. Technical Data: Internet protocol (IP) address, your login data, browser type and version, time zone setting and location, browser plug-in types and versions, operating system and platform, and other technology on the devices you use to access this website. Usage Data: Information about how you use our website, products, and services. How We Use Your Information We use information held about you in the following ways: To Fulfil Our Services: To dispense and deliver prescriptions and other products. To Communicate With You: Responding to your inquiries, providing information about changes to our services, and handling customer service interactions. For Legal Obligations: Complying with regulatory and legal obligations. For Marketing Purposes: Providing you with promotional materials or communications regarding products and services that may be of interest to you, where you have consented to be contacted for such purposes. Data Protection We take the security of your data seriously. We have implemented appropriate technical and organizational measures to protect your personal data against unauthorized or unlawful processing, accidental loss, destruction, or damage. Sharing Your Information Service Providers: We may employ third-party companies and individuals to facilitate our service (e.g., payment processors, technology service providers). Legal Requirements: We may disclose your information where required by law or subpoena. Business Transfers: If we are involved in a merger, acquisition, or asset sale, your personal data may be transferred. Your Rights Under UK data protection law, you have rights including: Access: The right to ask for copies of your personal data. Rectification: The right to ask us to rectify information you think is inaccurate or complete information you think is incomplete. Erasure: The right to ask us to erase your personal data, under certain conditions. Restriction of Processing: The right to ask us to restrict the processing of your personal data, under certain conditions. Object to Processing: The right to object to the processing of your personal data, under certain conditions. Data Portability: The right to request that we transfer the data that we have collected to another organization, or directly to you, under certain conditions. Contact Us If you have any questions about this Privacy Policy or our privacy practices, please contact us by e‑mail at info@drugs4delivery.com or phone at 01472 241990.Submit Confirm your details to get started Confidential & Secure Our prescribers will review your details in complete confidence Your medication will be delivered in plain unlabelled packaging Appears on your statement as “PIX*D4D” All data is securely encrypted with 128bit SSL Need help? If you need help with this medical assessment, contact our helpline:01472 241990or use our contact form