Patient Nomination Form

The Electronic Prescription Service (EPS) is an NHS service that allows your doctor surgery to send your prescription(s) directly to your nominated pharmacy electronically. This means that you no longer need to visit your doctor surgery to pick up your prescription(s) and drop it off at the pharmacy.

First Name *

Last Name *

DOB (DD/MM/YYYY) *

Address *

Postcode *

Phone Number *

GP Surgery *

Are you on Repeat Medication?

I give Topkins Pharmacy my consent to view my summary care records that are held on the NHS cloud for clinical checks.

Days	Open	Close
Monday	9am	6:00pm
Tuesday	9am	6:00pm
Wednesday	9am	6:00pm
Thursday	9am	6:00pm
Friday	9am	6:00pm
Saturday	9am	5:30pm
Sunday		Closed
We are closed on Sunday