Electronic Prescription Request

The Electronic Prescription Service is a free service, funded by the NHS, which involves prescriptions being sent electronically, in a secure and confidential manner, from your GP surgery to the place you choose to have your prescriptions dispensed. Click HERE for a full explanation of how the service works. If you wish to discuss, please call and ask to speak to the pharmacist.

You MUST still order your prescription using your GP Surgery's services EVERY month and it will be ready within 48 hours.

Just complete the form below and we will do the rest for you!
Fields marked with a tick () MUST be completed.

Patient Details:

Name:

Address:

Date of birth:

Telephone:

Email:

Gender:

Male

Female

NHS number:

If you are a representative of the patient please fill in your details below:

Representative Details:

Name:

Address:

Relationship:

Telephone:

Email:

I would like to nominate:

Skeltons Chemists Ltd.
2 Congreve Walk, Bedworth, CV12 8LY.

to receive my prescriptions via the Electronic Prescription Service

Please tick here if you DO NOT wish to be contacted about other healthcare services offered by this pharmacy:

Please tick here to confirm that you understand what the Electronic Prescription Service is AND what nomination means: