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NHS Electronic Prescription Service

As part of the changes to the NHS service you can now select to have your prescription sent directly to a pharmacist who will then prepare the medicines for you ready for collection at our pharmacy.

If you would like Numark to be your nominated pharmacy please complete the form below.
 
Prescriptions can be picked up from the Shepshed branch only.

This NHS service is free of charge.

NHS Electronic Prescription Service (EPS) Patient Nomination Request and Repeat Prescription Service Consent Form

 
 

 
 
 
  


Please provide your name and address if you are a representative of the patient.






I understand that EPS is an NHS funded service and the Repeat Prescription Service is a separate service run by this pharmacy.

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.

I give my consent for my nominated pharmacy to retain my repeat prescription request slip and for them to verify items with me prior to re-ordering from my GP surgery

I give my consent for my nominated pharmacy to contact me when my repeat prescription is ready for collection.

I give my permission for my nominated pharmacy to hold the information provided on this form.




 


  
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