Would you like to simplify how you get your NHS medication?

Simplified NHS prescription service

Your Details

First Name
Date of birth
Phone *
* Please supply a contact number in case we need to contact you urgently
Would you like your medication delivered to your home address?
To improve your experience we may post your items through your letterbox subject to size. I confirm and consent, that it is safe and suitable for Chemist-4-U to post the medication through the letterbox.


Do you pay for your prescriptions?
A patient is exempt if they do not have to pay for their prescriptions, if they:

Optional - these will improve the service for you

If you would like a reminder or for us to order on your behalf (If your surgery permits) please enter when you will run out of your medication

Declaration and Consent

I declare that the patient does not have to pay NHS prescription charges, is properly entitled to exemption and that the information is true and complete. I also declare that if the entitlement changes, I will tell Chemist4U immediately on 01695 474433, and I understand that if I do not do so, appropriate action may be taken.

I understand the services you provide and want to register to use them. I understand EPS nomination and nominate you to collect my prescriptions on my behalf either via EPS or direct from my GP. I understand that by signing this from I give permission for my prescriptions and information about my repeat medicines to be sent electronically between my doctor and Chemist4U

First Name
Agent Id (if applicable)