Electronic Prescription Service

The Electronic Prescription Service (EPS) is an NHS Service that allows your GP to send your prescriptions electronically to any pharmacy of your choice. As the patient, you need to select a pharmacy to which your prescriptions should be sent. This process is called Nomination. You may nominate a pharmacy of your choice and can cancel your nomination at any time. To nominate Bencrest Chemist please fill in the form below.

Your Details

Full Name *

Address *

Address

Address Line 1

Address Line 2

Town/City

County

Postcode

Telephone Number *

Date of Birth *

NHS Number

If known

Additional Registrants *

I would like to include additional registrants living at the same address

Additional Registrants

Full Name *

Telephone Number *

Date of Birth *

NHS Number

If known

Add Registrant Remove Registrant

Doctor’s Details

Select your Doctors Surgery * Select your Doctors Surgery

Declaration

I understand the repeat prescription service as provided by Bencrest Chemist and would like to register to use this.

I understand the EPS nomination process and would like to nominate Bencrest Chemist to collect prescriptions, whether paper or electronic, on my behalf direct from my GP.

By submitting this form I authorise my GP to issue all my prescriptions directly to Bencrest Chemist.

I understand that providing false information on this form may lead to legal action being taken against me.

Bencrest Chemist respects your privacy and will only use any information provided for the process stated above.

Declaration *

By selecting this you are authorising your GP Surgery to send all your prescriptions (Paper and electronic) to Bencrest Chemist

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Electronic Prescription Service

Your Details

Additional Registrants

Doctor’s Details

Declaration

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