Title* Full Name* Date of birth* NHS Number Phone* Email Address* House Number and Street* City* Country* Postcode*

The Summary Care Record contains key health information like your medications and allergies. It helps healthcare staff provide safe care.

1I give E-Pharmacy consent to access my Summary Care Record for dispensing medications.

You can opt-out of sharing your Summary Care Record anytime by contacting us or your GP.

1I agree to have E-Pharmacy receive and dispense my NHS prescriptions electronically.
1I agree to E-Pharmacy's terms & conditions and privacy policy.

EPS Nomination Form

Complete this form to sign-up