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Your Personal Details
Your GP Surgery Details
Are you exempt from NHS prescription charges?
Your Medication Details (Optional)
You may also get in touch with us over the phone or email after submitting the form to add your medications.
Your initial sign up may take up to 5-7 days to be set up.
If you have more than 5 medicines, you can fill in the form again to add additional medicines or get in touch with us through contact us page (link opens in a new tab).
I understand the Evercaring Pharmacy Repeat Prescription service and EPS (Electronic Prescription Service) and would like to nominate Dr. Rani Ltd. to collect my prescriptions on my behalf.
Learn more about EPS (Link opens in new tab)
I give permission for Evercaring Pharmacy to access my Summary Care Record in order to identify me correctly and provide the best possible care
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I give permission for information about my medications to be sent between my doctor and Evercaring Pharmacy.
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