Village Health Group - Nominate Your Chemist

By nominating a chemist, your prescription could be sent electronically to the chemist - meaning no waiting to collect your paper prescription before taking it the the pharmacy. It also means our prescription team can process prescriptions quicker as a whole, making your experience with Village Health Group more satisfying overall. Please note that due to NHS Guidance, some items (such as specific Epipens), may not be able to be sent electronically, but will still be printed as usual instead if appropriate.

Last Updated: 17/12/2020

Your Details

Please select the branch you are registered with: *

East Leake

Keyworth

Ruddington (Church House)

Sutton Bonington

Name *

Date of Birth *

Phone Number *

Email Address *

Name of your Chosen Pharmacy *

Postcode of your chosen pharmacy *

Signed *

Dated *

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. *

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Village Health Group - Nominate Your Chemist

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