Living Care Pharmacy

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Email address

Password

Confirm password

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Title:

First Name:

Surname:

Date of Birth:

Phone Number:

Home Postcode:

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Postcode:

Please Enter a Postcode, to view local GP'S

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How would you like to receive your medication?

Collection Branch:

Delivery Address:

Specific Safe Place:

Select how you would like to order your prescription with us?

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Do you normally pay for your medication?

Yes No

Exemption Status

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Patient Declaration

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 information 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

Marketing preferences

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

Head Office
Unit 3 Leodis Court
Leeds
LS11 5JJ

0113 243 4441
office@livingcarepharmacy.com