Nominate Us

Allow us to look after your prescriptions.
Simple sign up.

The information below will only be used to process your prescription and nothing else. If you have any queries or prefer to nominate over the phone then please call 01625 523414 or 01625462043

Nominate Wilmslow Pharmacy

* Indicates required field

First Name *

Last Name *

NHS Number (normally at the top of your prescription- don't worry if you do not know) *

Gender *

Postcode *

Date of Birth *

Email *

Phone Number *

How can we help? *

Please contact me to discuss / not sure I need you to order my prescription now. I'm just signing up for my future prescriptions

Comments *

Consent *

I am the patient named above/carer of the patient named above. Nomination has been explained to me and I have also been offered a leaflet that explains nomination. I would like to nominate Wilmslow Pharmacy as my nominated pharmacy for dispensing prescriptions issued by the NHS Electronic Prescription Service.

Submit

Allow us to look after your prescriptions. ​Simple sign up.

The information below will only be used to process your prescription and nothing else. If you have any queries or prefer to nominate over the phone then please call 01625 523414 or 01625462043

Nominate Wilmslow Pharmacy

MHRA Company number: C39636

Allow us to look after your prescriptions.
Simple sign up.