Living Care Pharmacy

NHS Prescription Registration Form

Your Details

We just need a few personal details to create your online account.

Title:

First Name:

Surname:

Date of Birth:

Contact Number:

Email Address:

Are You the Patient:

Postcode:

Online Account Details

An online account will enable you to update your details quickly and easily:

Email Address:

Password: Show

Confirm Password: Show

Doctor Details

It would be helpfull to know the GP of the patient, so please enter the postcode below.

Don't worry if you don't know the post code of your GP, you can skip this section if you want.:

Postcode:

Please Enter a Postcode, to view local GP'S

Service Options

Details of how you would like to receive your delivery.

Payment & Exceptions

Details of how you pay for your prescriptions.

Do You Normally Pay for your Prescriptions:

Patient Details

We want you to know exactly how our service works and why we need your registration details. Please state that you have read and agreed to these terms before you continue.

I agree to the terms and conditions

In order to improve our service to you, we would like to access your Summary Care Record and discuss your care with your GP. This infomration will only be accessed once and will be kept strictly confidential at all times.

I give my authority to view my Summary Care Record and discuss my care with my GP

Contact permission

We’d love to send you exclusive orders and the latest information from Living Care Pharmacy by email, SMS, phone or other electronic means. We’ll always treat your personal details with the upmost care and will never sell them to any company.

Please let us know if you would like us to contact you or not by selecting one of the options below.

Yes, I'd like to hear about offers and services by SMS

Yes, I'd like to hear about offers and services by email/other electronic methods

Yes, I'd like to hear about offers and services by phone

No, I do not want to hear about new offers or services

Patient Details

Details of the patient so we can register them for the service.

Title:

First Name:

Surname:

Date of Birth:

Postcode:

Head Office
Unit 3 Leodis Court
Leeds
LS11 5JJ

0113 243 4441
office@livingcarepharmacy.com

NHS Prescription Registration Form

NHS Prescription Registration Form

Your Details

Online Account Details

Doctor Details

Service Options

Your Local Living Care Pharmacy

Delivery Options

Medicines Packaging

FREE Reminder Options

Payment & Exceptions

Patient Details

Contact permission

Patient Details