Prescriber Registration

Please complete this form with your required details. You will be contacted via your prescriber email address once your identity has been verified and registration approved, typically within one working day

Note: This website is for prescribing healthcare professionals only including but not limited to doctors, dentists, nurses and pharmacists.

Prescriber Details

Title *

First Name *

Surname *

Email Address *

Password *
containing at least 8 characters including:

A lowercase letter
An uppercase letter
A number
A special character for example !, @, *

Confirm Password *

Mobile Number *

Clinic Details

Clinic Name *

Postcode *

Address Line 1 *

Address Line 2

Town *

County

Email Address *

Telephone Number

Clinic Regulatory Premises Number

Verification Details

Please upload the following documentation:
File types accepted .doc, .docx, .pdf .jpeg, .jpg, .png, .gif (Maximum file size: 10MB)

Documents accepted - driver's licence or passport *

Choose a file

Indemnity Insurance

Choose a file

Professional Body Registration Details *

GMC

GDC

GPhC

NMC

Other

Your Signature

Please write your signature in the box below, this will be shown on the PDF version of your submitted prescriptions *

I have read, understand and agree to the Prescribers Terms and Conditions *

I have read, understand and agree to the Terms of use *

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