Consent Form
I am the patient named in this submission. Or I am the carer of the patient named in this form. Nomination has been explained to me and I have also been offered a leaflet that explains nomination.
I would like to nominate SmartCare Pharmacy as my nominated pharmacy for dispensing prescriptions issued by the NHS Electronic Prescription Service until future notice.
If you need a copy of the nomination leaflet which incorporates the consent form then please download here
Nomination leaflet
Download leaflet
Telephone : 0208 903 4065
Unit B - Wembley Park Road, Wembley. HA9 8HP
Monday to Thursday:
9:00am -18:00pm
Friday: 09:00-12:00pm
14:00pm-19:00pm
Owner: Smartcare Pharmacy Ltd.
GPHC No: 9010056
Providing services for the NHS
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