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Add your personal details below. Please enter the details your GP will have on record so we can match you to your GP.
Name*
Date of birth*
Address*
Enter postcode, surgery name or town to search OR select GP surgery not listed
Enter details above
How would you like to get your prescriptions?*
Please sign below*
  • Your Name
  • Your Name
  • Your Name
I agree to make Capsule Pharmacy my chosen pharmacy. This means Capsule Pharmacy retain my repeat prescription re-order slip, request prescriptions from my surgery and collect prescriptions on my behalf either in person or by electronic transfer.