Medicine Information Service for Healthcare Professionals Healthcare professionals may use this form to submit enquiries to the South West London & St George's Mental Health NHS Trust Medicines Information Service. First Name* Surname * Job role Consultant Registrar Junior Hospital Doctor GP Hospital Pharmacy Staff Community Pharmacy Staff Practice Pharmacist PCT Advisor SHA Advisor Hospital Nurse/Midwife Primary Care Nurse/Midwife Walk-in Centre Staff Dentist Profession Allied to Medicine Other How would you like to receive your reply? Email Telephone Text PostOrganisation (and department where applicable) * Please enter your email address or telephone fax number Does your question involve a specific patient? No Yes If Yes: Patient's initials Date of Birth NHS number (if known) (optional)RIO Number (if known) (optional)Patient identifiers not known When do you need an answer? Please note that we will contact you if we cannot meet this deadline. Please give a specific date. Your question. Use the categories in the The UKMi Quick Question Guide to help identify what additional background information we would need to answer this type of question. This helps to ensure we provide you with an appropriate answer and may help to reduce the time it takes for us to reply to your question. * This form will send the personal information you have entered to us via email. This will be treated in the strictest confidence. We will use the personal information to respond to your enquiry. Your enquiry will be researched by our Medicines Information team. If you would prefer to speak a member of our Medicines Information team, please contact us on 02035136829 (external) or extension 6829 (internal).