Register & nominate us

Nominate Patient Pharmacy as your NHS pharmacy and we’ll manage your repeat prescriptions and deliver them free, anywhere in England. Fill in the form below and we’ll take care of the rest — nothing to post.

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Your details

First name

Last name

Date of birth

NHS number (if known)

Mobile number

Home address

Postcode

Town / city

Your GP surgery

GP surgery name

GP surgery address / town

Your regular medicines

List the medicines you take regularly (optional — we’ll confirm with your GP)

Declaration & signature

Signature

Sign with your mouse or finger