NHS Registration | Welpharm Online Pharmacy

Doctors Surgery

Name*

Telephone*

Surgery Address*

Create Your Account

Email Address*

Password*

Your Patient Details

Title*

First Name*

Surname*

Date of Birth*

Gender*

Male
Female

Your Home Address

Telephone*

Mobile Number

Home Address*

Prescription Reminder

Set up a Reminder?

Yes
No

Date of Next Prescription

Allergies & Health Problems

Enter any allergies or health problems

Family Members

Let us know if any family members have any medical conditions

Payment Details

Do you normally pay for your prescriptions?*

Yes
No

If you are exempt from paying for prescriptions, please select your exemption type below.

Expiry Date

Please send us a copy of your passport or identification card to prove your age. Our contact details can be found on the contact page..

Please send us a copy of your enrolment confirmation letter. Our contact details can be found on the contact page.

Please send us a copy of your maternity exemption certificate FP92. Our contact details can be found on the contact page.

Please send us a copy of your medical exemption certificate FP92. Our contact details can be found on the contact page.

Please send us a copy of your prescription prepayment certificate FP96. Our contact details can be found on the contact page.

Please send us a copy of your War Pensions Agency form. Our contact details can be found on the contact page.

Please send us written proof that you receive Income Support. e.g. Giro letter or your Income Support Order Book or tear-off portion. Our contact details can be found on the contact page.

You may not to have any evidence to prove this - do not worry as a note will be made of this and it will be checked later. Our contact details can be found on the contact page.

Please send us a copy of your HC2 charges certificate. Our contact details can be found on the contact page.

Please send us a copy of your NHS Tax Credit Exemption Certificate. Our contact details can be found on the contact page.

Please send us a copy of your partner's pension book, letter or bank statement showing payment from the Department of Work and Pensions. Our contact details can be found on the contact page..

You have indicated that you are prescribed free-of-charge contraceptives, no proof required.

We’ll contact you for payment on receipt of order.

Terms & Conditions

Agree to the terms and conditions*

Yes, I agree

Opt out of marketing emails

Yes

I understand WelPharm services and wish to register for their use. I understand EPS nomination and nominate WelPharm to collect my prescriptions on my behalf either via EPS or directly from my GP. I understand that by signing this form I give consent for my prescriptions and information about my repeat medicines to be sent electronically between my doctor and WelPharm

By clicking on continue you agree to our Terms & Conditions