Free Prescription Delivery

Just answer a couple of questions and we will organise to get your prescriptions delivered to your home or workplace – completely free! Dickson Chemist are always happy to register new NHS patients, even if you have never been with us before.

This form lets you quickly sign up for a repeat prescription service, or request a review for a compliance aid/dosette box.

* Denotes a required field

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Your Details

What is your name? *

What is your date of birth? *

What is your email? (optional)

What is your home address? *

What is your phone number, or the best number to call you on? *

Who is your GP? *

I would like a dosette box *
YesNoI don't knowOther

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If other, please enter details *

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Type a list of all your medications here that you take regularly, don't worry about spelling - we will figure it out! *

I understand that I can only access this service if my delivery postcode is one of the following:
G1, G11, G12, G13, G14, G20, G21, G31, G32, G33, G34, G40, G5, G69, G71, G72, G73, G74, ML3, ML4, ML5, ML6

I formally consent for Dickson Chemist to act on my behalf, register me for the relevant NHS services (EMAS, CMS, PHS) and provide deliveries to my home if required. If appropriate I authorise Dickson Chemist to take over managing my repeat prescriptions and working with my doctor directly.