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If you would like to take part in a test of Echo by Lloyd's Pharmacy, please enter your details and answer the questions below.

This product test is open to Mumsnet users who have a repeat prescription or manage a repeat prescription for a family member.

Thanks and good luck!

MNHQ

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* 1. Please enter your details below:

First Name(s)

Surname

Address line 1

Address line 2

Address line 3

Address line 4

Postcode

Usual Mumsnet username

Email address

Mobile number

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* 2. How old are you?

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* 3. Do you personally have a repeat prescription?

Yes

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* 4. Do you manage a repeat prescription for someone else?

Yes - family member I live with

Yes - family member I don't live with

Yes - someone else

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* 5. When are you next due to to collect a prescription?

In the next two weeks

Two weeks to a month from now

One to two months from now

Two to three months from now

Three or more months from now

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* 6. How often do you collect a prescription?

If you collect prescriptions for more than one person, please answer for the most frequent.

Weekly

Fortnightly

Monthly

Once every two months

Once every three months

Once every four months

Once every five months

Once every six months

Less often

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* 7. Why would you like to test Echo by Lloyd's Pharmacy?

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* 8. If you are selected, we will need to send your details (name and email address) to Echo by Lloyd's Pharmacy so that they can confirm you've signed up. We will NOT pass on your Mumsnet username. Please confirm if you'd like us to do this.

Yes - I'd like my name and address, plus mobile number and email address if appropriate, to be passed on to Echo by Lloyd's Pharmacy so that they can confirm if I've signed up.

No - I would not like my details to be passed on.

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* 9. If you are selected, we will use your contact details to communicate logistics of the product test and remind you to give your feedback. Please indicate below if this is something you'd like.

Yes - I'd like my email address and mobile number to be used by Mumsnet to contact me with updates about the product test if I'm selected.

No - I would not like my details to used in this way.

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* 10. If you are NOT selected, there may be a voucher or coupon available to non-testers. Please indicate below if you'd like to receive an email about this.

Yes, I'd like to receive an email about a voucher or coupon if I'm not selected and this is available

No, I wouldn't like this

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* 11. If you're not currently a member, would you like us to send you information on joining the Mumsnet Insight Panel?

N/A: I'm already on the Mumsnet Insight Panel

No, I'm not interested

Yes, I'd like to hear more

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* 1. Please enter your details below:

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* 2. How old are you?

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* 3. Do you personally have a repeat prescription?

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* 4. Do you manage a repeat prescription for someone else?

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* 5. When are you next due to to collect a prescription?

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* 6. How often do you collect a prescription?If you collect prescriptions for more than one person, please answer for the most frequent.

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* 7. Why would you like to test Echo by Lloyd's Pharmacy?

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* 8. If you are selected, we will need to send your details (name and email address) to Echo by Lloyd's Pharmacy so that they can confirm you've signed up. We will NOT pass on your Mumsnet username. Please confirm if you'd like us to do this.

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* 9. If you are selected, we will use your contact details to communicate logistics of the product test and remind you to give your feedback. Please indicate below if this is something you'd like.

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* 10. If you are NOT selected, there may be a voucher or coupon available to non-testers. Please indicate below if you'd like to receive an email about this.

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* 11. If you're not currently a member, would you like us to send you information on joining the Mumsnet Insight Panel?

* 6. How often do you collect a prescription?

If you collect prescriptions for more than one person, please answer for the most frequent.