MX Services
Dressings and ostomy supplies
Erectile Dysfunction Service
Minor Ailments
Morning after pill
Medicines Use Review
Order My Prescription
Palliative care Pharmacy Lancashire
Passport Photos
Prescription Collection + Delivery
Stop Smoking Service
Read Blog
Travel Clinic
MX Travel Clinic
Hajj and Umrah
Tick borne Encephalitis
Vaccinations
Flu Service
Hep B Vaccination service
Pneumonia Jab
Shingles
Alphega Pharmacy App
Contact Us
Electronic Prescription Service Consent Form
If your doctor is transmitting prescriptions electronically then we can recieve your prescriptions via the NHS spine but before we can do that you will need to nominate MX Pharmacy as your chosen pharmacy. Please complete the form below to nominate MX Pharmacy. To read more about electronic prescription service please click
here
.
*
Indicates required field
Name
*
First
Last
Please fill in your name,
Address
*
Your address here please
Town
*
Postcode
*
This will help us if we need to deliver to you
Email
*
e-mail please so we can confirm that your a human and not a computer
Date of Birth
*
So we can find you on the NHS database.
Surgery
*
Surgery name, so we go to the right surgery
Doctor
*
Finally your doctors name here please, almost there!
I give consent to MX Pharmacy to collect and dispense my paper and/or electronic prescriptions
*
Nominate MX
Submit
MX Services
Dressings and ostomy supplies
Erectile Dysfunction Service
Minor Ailments
Morning after pill
Medicines Use Review
Order My Prescription
Palliative care Pharmacy Lancashire
Passport Photos
Prescription Collection + Delivery
Stop Smoking Service
Read Blog
Travel Clinic
MX Travel Clinic
Hajj and Umrah
Tick borne Encephalitis
Vaccinations
Flu Service
Hep B Vaccination service
Pneumonia Jab
Shingles
Alphega Pharmacy App
Contact Us