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NHS
NHS Prescriptions Sign up Form
Please fill in the form below to nominate Simply Prescriptions as your pharmacy
You can only register for NHS Prescription dispensing if you live in England. We cannot register you if you reside in Wales, Scotland or Northern Ireland.
Title
Mr
Mrs
Ms
Miss
Prof
Dr
First Name*
Last Name*
Email*
NHS Number*
Date of Birth*
Gender*
Select
Female
Male
Telephone No*
Postcode
Find Address
Address 1
Address 2
Address 3
City
Country
Select a Country
United Kingdom
Bulgaria
Cyprus
Denmark
Finland
Germany
Ghana
Greece
Iceland
Lithuania
Luxembourg
Malta
Romania
Slovakia
Slovenia
Ireland
Password*
Confirm Password*
Exemption Status
THE PATIENT PAYS FOR THEIR PRESCRIPTIONS
is 60 years of age or over or is under 16 years of age (unless your date of birth is printed on the form)
is 16, 17 or 18 and in full time education
Maternity exemption certificate
Medical exemption certificate
Prescription prepayment certificate
HRT only prescription prepayment certificate
Ministry of Defence prescription exemption certificate
HC2 (full help) certificate
Income-related Employment and Support Allowance
Tax Credit exemption certificate
Pension Credit Guarantee Credit (including partners)
Universal Credit and meets the criteria
Exemption Certificate Number
Exemption Certificate Expiry Date
Agreement
I am the patient named above/carer of the patient named above
I understand that I am nominating Simply Prescriptions to receive my NHS prescriptions via the Electronic Prescriptions service for dispensing.
I understand the meaning of nomination and how it works.
Did you get a referral code? Please enter it here
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