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I am the patient/patient's representative and would like to register to use the selected pharmacy in this form for the NHS Prescription Service, I understand EPS nomination and nominate Allied Pharmacies to dispense my prescriptions. By signing this form, I give permission for information about my repeat medicines to be sent between my doctor and the selected pharmacy.
If I have stated I am exempt from payment, I confirm I am properly entitled to exemption and that if my entitlement changes, I will tell you immediately