EPS Nomination

Please complete this form to nominate THE PHARMACY LEEDS as your designated pharmacy and to sign up to our FREE Prescription Delivery Service, ensuring that all the information is entered accurately. By filling in this form, you give consent to your Doctor to send all your electronic prescriptions to our pharmacy. You can change this nomination at any time.












    By ticking this box you are consenting to your future prescriptions being sent electronically to THE PHARMACY LEEDS. We will then dispense your prescriptions and deliver them to you. You can change this nomination at any time.