Inhaler Recycling Kit Order Form

To order your Inhaler Recycling Kit, simply fill out the form below or for more information call 0800 389 4644

Pharmacist Full Name *

Name of Teva Scheme *

Teva Account Number *

Pharmacy Name and Address *

Town/City *

County *

Postcode *

Delivery Address if different to Pharmacy

Town/City *

County *

Postcode *

Contact Name *

Telephone Number * Example 01234 123456

Email Address *

Confirm Email Address *

I meet the criteria to receive the Inhaler Recycling Kit free of charge

Please contact me to arrange payment of £100 + VAT per kit

Please allow 28 days delivery from receipt of the order and payment if applicable.