Electronic Prescription consent form

Electronic Prescription Service Consent Form

If your doctor is transmitting prescriptions electronically then we can recieve your prescriptions via the NHS spine but before we can do that you will need to nominate MX Pharmacy as your chosen pharmacy. Please complete the form below to nominate MX Pharmacy. To read more about electronic prescription service please click here.

* Indicates required field

Name *

First

Last

Address *

Town *

Postcode *

Email *

Date of Birth *

Surgery *

Doctor *

I give consent to MX Pharmacy to collect and dispense my paper and/or electronic prescriptions *

Nominate MX

Submit