Electronic Prescription Service | Nominate Goldchem Pharmacy for Electronic Prescription

Electronic Prescription Service (EPS) allows GP surgeries to automatically send your prescription directly to a pharmacy of your choosing.

By nominating Goldchem Pharmacy as you designated pharmacy, using form below, we will arrange for your GP to automatically send your prescription to us. We will have your medications ready for pick-up at your convenience or, if appropriate, delivered to you free of charge.

Registration Form

* Mandatory fields

Prefix *

First Name *

Last Name *

Date of Birth *

E-mail *

Phone Number *

Mobile Number(if different)

Gender *

NHS Number (if known)

Address *

City *

Country *

Postcode *

Comments (optional)

I consent to participate in the following services should I require them: NHS New Medicine Service (NMS), NHS Medicine Usage Review (MUR), NHS Electronic Prescription Service (EPS), Patient Nomination Request (PNR), Repeat Prescription Collection Service (RPCS), Repeat Prescription Delivery Service (RPDS), Dispensing Appliance Contractor (DAC) Nomination (Walton Surgical Appliances), Access to my Summary Care Record (SCR).

I understand that the information I provide as part of these services may be shared with my GP practice or other clinical staff. I understand that the NMS, MUR and EPS are NHS-funded and I consent for these services to be provided on my behalf. I have not been influenced or incentivized for doing so. I agree for my information being used in an anonymous format for statistical and research purposes, aimed at improving care. I can withdraw my nomination at time by contacting the pharmacy.

147a Albert Road, Southsea,
Portsmouth, PO4 0JW,UK

Registration Form

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