Nominate this Pharmacy

Fill in your details below to nominate Brighouse Pharmacy as your preferred pharmacy. We will handle your repeat prescriptions, offer free delivery, and give you access to our full range of clinical services.

Your Details

Please provide your personal information so we can set up your nomination.

First name

Last name

Date of birth

Phone number

Email (optional)

Address

Address line 1

Address line 2 (optional)

City / Town

Postcode

GP Surgery

GP surgery name

Consent

I confirm that I am nominating myself and wish for Brighouse Pharmacy to manage my repeat prescriptions. I consent to the pharmacy collecting and delivering my medication on my behalf.