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

Learn more about Summary Care Record (Link opens in new tab)

I give permission for information about my medications to be sent between my doctor and Evercaring Pharmacy.

I agree to the Evercaring Pharmacy terms, conditions and privacy policy.

Terms and conditions (Link opens in new tab)

Privacy Policy (Link opens in new tab)

Tick to accept

We may need to contact you from time to time. Please select the methods we may contact you.

We respect your privacy. We will use your personal information in line with our privacy policy. We will not sell your information to anyone for any reason.

You allow us to contact you on the phone number and email provided.
We abide by UK Data Protection Laws and Regulations.

Allow contact by email
Allow contact by phone
Allow contact by mail

Total: £