User Register

All boxes are mandatory, unless stated otherwise.

Your Details
 
 
 
     
   


  
  
This must be at least 6 characters, including one number and no special characters (e.g. !?.,)
Address Details
 
 
 
  
Work Address Details

This is only needed if you require the option to have your prescriptions delivered to a work address

 
 
 
 
 
  
Account Information
 


Prescription Charges

Please select from below


If exempt from paying Prescription Charges, please select the exemption reason from below:

 
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