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15 St Peter's Hill, Grantham, Lincolnshire, NG31 6QA
01476570912
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Home
Services
Flu Vaccination
Vitamin B12 Injection
Weight loss
Hair Loss
EPS Nomination
Repeat Prescriptions
Private Prescriptions
Repeat Dispensing
All Services
Travel Clinic
Travel Vaccine
Speciality Vaccine
Hajj and Umrah Vaccination
Antimalarials
Vaccine Prices
Contact
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EPS Nomination Form
EPS Nomination
REGISTERING
Please Select
Myself
Someone Else
TITLE
Please Select
Mr
Mrs
Ms
Prof
Dr
FIRST NAME
LAST NAME
DATE OF BIRTH
PHONE NUMBER
EMAIL ADDRESS
NHS NUMBER (OPTIONAL)
ADDRESS
TOWN / CITY
POST CODE
EXEMPTION
Exemption Status
PAYING Patient (NOT EXEMPT)
A. Under 16 years of age
B. Full-time Students aged 16, 17 or 18
C. 60 years of age or over
D. Maternity Exemption
E. Medical Exemption
F. Prescription Pre-payment Certificate (PPC)
G. War Pension Exemption
L. HC2 Charges Certificate
X. Free-of-charge contraceptives
H. Income Support (IS)
or Income-related Employment and Support Allowance (ESA)
K. Income-based Jobseeker’s Allowance (JSA) or Universal Credit (UC)
M. NHS Tax Credit Exemption
S. Pension Credit (Guarantee Credit) paid on its own, or Pension Credit (Guarantee Credit with Savings Credit)
ORDERING
Please Select
I would like St Peters Hill Pharmacy to set up a repeat schedule and order with my consent.
I would like to order myself (contacting St Peters Hill Pharmacy or the surgery directly)
WOULD YOU LIKE TO MAKE A REPEAT REQUEST NOW?
Please Select
Yes
No
CHECK ME OUT I UNDERSTAND WHAT NHS ELECTRONIC PRESCRIPTION SERVICE NOMINATION IS (PLEASE SEE FURTHER INFORMATION BELOW).
I WOULD LIKE TO USE St Peters Hill Pharmacy AS MY NOMINATED PHARMACY ALLOWING THEM TO DISPENSE/DELIVER MY PRESCRIPTIONS VIA THE NHS ELECTRONIC PRESCRIPTION SERVICE.
Submit
