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Nominate Us

Patient Name *

Patient Address *

Patient Town *

Patient Postcode *

Patient Phone *

Patient's Surgery *

I am the (select one)

Representative Name

Representative relation to patient

I am the patient named above/carer of the patient named above. Nomination has been explained to me and I have also been offered a leaflet that explains nomination. Also available to download/print here: www.hscic.gov.uk/epspatients

I would like to nominate the Pharmacy named below as my nominated pharmacy for dispensing prescriptions issued by the NHS Electronic Prescription Service.

I confirm that I have made my nomination of my own free will and have not been influenced or given a gift to select a particular nomination and that I can change my mind at a later date

Nominate

PHARMACY RELATED

What are the maximum quantities of items allowed on a prescription?

Quantities should reflect the number of items needed to treat a single patient

Can I order POMs if I am not a prescriber?

You can process the order providing you have a prescription written by a prescriber who is aware that you will be processing the order on their behalf.

Your account doesn’t need to be in the prescriber’s name. You will have to provide the prescribers telephone number as we need to confirm that a face-to-face consultation has taken place.