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EPS Nomination

Please complete this form to nominate Online Delivery Chemist to dispense your prescriptions. Please ensure that all the information is entered accurately. By filling in this form you are asking your doctor to send all your electronic prescriptions to our pharmacy. You can change this nomination at any time.












    By ticking this box you are consenting to your future prescriptions being sent electronically to Online Delivery Chemist. We will then dispense your prescriptions and deliver them to you. You can change this nomination at any time.