NHS-Thank you

Do you currently take regular medication?*

Email Address*

Confirm Email Address*

How did you hear about us?*

To ensure we receive your prescriptions electronically, please make sure the details entered here match what is registered with your GP surgery.

I'm registering:*

Please fill out the form from the perspective of the person you are registering for.

Title*

First Name*

Last Name*

Date of Birth*

Gender*

Contact Number*

We need a contact number to contact you regarding your medication if needed.

Do you normally pay for your prescriptions?*

Please note: free of charge contraceptives will appear at zero price when prescribed

Would you like to purchase NHS prescription pre-payment certificate?*

Certificate Price*

Certificate Start Date*

Reason:*

Please Note: Pre-Payment Prescription Certificate will be sent over to your email in the next 24 Hours.

Total Amount:

Certificate

Price: £ 0.00

Address Line 1*

Adddress Line 2

City

Postcode*

Total

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Country

Would you like to receive your medication through your letterbox*

Please note that controlled drugs and refrigerated items require a signature upon delivery.

Would you like to set a safe place for Royal Mail to leave your delivery?

Select place

Your Royal Mail Safe Place:

Total

Total

Phone

This field is for validation purposes and should be left unchanged.