Nominate Your Pharmacy

This form allows you to choose which pharmacy you would like your electronic prescriptions to be sent to. Your nomination will remain in place for future prescriptions until you decide to change it.

By nominating a pharmacy, your prescriptions will be sent electronically directly to your chosen pharmacy. You can collect your medicines without having to hand in a paper prescription, and you'll save time as your prescription will be ready to collect when you arrive.

Please note: You can change your nomination at any time by completing this form again.

Last Updated: 13/12/2024

YOUR DETAILS

Please provide as much detail as possible

Name *

Date of Birth *

Phone Number *

Email *

YOUR PHARMACY DETAILS

Your prescription will be sent electronically. Please fill in the correct pharmacy details - If you are unsure of the pharmacy details then use the button below.

FIND A PHARMACY

Pharmacy Name (eg. Cohens) *

Pharmacy Address (Use the 'FIND A PHARMACY' button above, if unknown) *

What date should this nomination start? *

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

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Nominate Your Pharmacy

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