EPS Nomination

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Complete this form to sign-up

Please complete this EPS Nomination Form to nominate us as your online pharmacy, ensuring that all the information is entered accurately.

Please note that you will need to inform your GP surgery that you have nominated E-Medicina as your pharmacy. 

 

    Personal details

    Surgery details

    Exemption

    Please upload ID to prove your identity. (passport or driver's license accepted as valid ID)
    By ticking this box you are consenting to your future prescriptions being sent electronically to E-Medicina. We will then dispense your prescriptions and deliver them to you. You can change this nomination at any time.