Electronic Prescriptions Registration

You have chosen to nominate:

Send your EPS Nomination to Church Road Pharmacy by completing the form below. * indicates a required field.

Tell us about you:
Additional Information:

To help us set your EPS Nomination we require the following information to locate your nomination record on the NHS database.

Declaration:
  • Nomination has been explained to me by staff at my GP practice/ community pharmacy/ appliance contractor. I have retained the leaflet providing an overview of EPS and ‘nomination’ and I understand what I have to do.
  • I understand that EPS is an NHS-funded service and the Repeat Prescription Collection Service is a separate service run by the 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.