Please complete the once off registration and consent form below in order for us to automatically advertise these campaigns to your customers on behalf of your Pharmacy. *
Required
Your Name: *
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Pharmacy Name: *
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Pharmacy BHF / Practice Number: *
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Pharmacy Contact Number: *
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Pharmacy WhatsApp Number
Another way to communicate with your Patients. If you need assistance, contact us.
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Pharmacy Email Address: *
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I'd like to do the following:
Specify Pharmacy Delivery Information *
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Trading Hours (Please specify in detail for all days of the week) *
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Pharmacy Group Branding
A copy of your responses will be emailed to the address you provided.