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Pharmaself24 Signup Form

The Pharmaself24 enables you to collect your prescription 24 HOURS A DAY – 365 DAYS A YEAR. To sign up for this service please either download the form, complete and deliver to the surgery or complete the online form below.


Pharmaself24 Signup
Please use format day/month/year e.g. 12/05/1979
It is ESSENTIAL that you provide your mobile number as we will be required to send you an SMS text message each time you have a prescription with your unique PIN number.
Your request for Pharmaself24
Please type your name to indicate your signature

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.