Pharmacist Registration

Required fields

Before starting we recommend you scroll down to make sure you have all the information and files required where marked with

Title

Forenames

Surname

DOB

(dd/mm/yyyy)

Address

Postcode

Home Tel

Mobile

E-mail Address

Confirm E-mail

Nationality

Gender

Male Female

GPhC Reg No

Date of Registration

(dd/mm/yyyy)

NI Number

Do you have Professional Indemnity Insurance?

yes no

Expiry date

(dd/mm/yyyy)

Do you have a enhanced DBS certificate?

yes no

Preferred Location of work

Do you have a car?

yes no

NMS Accreditation

yes no

Repeat Dispensing

yes no

CPCS

yes no

DMS

yes no

FLU VAC

yes no

Multi-Site Smartcard

yes no

National SCR Access on Smartcard

yes no

Do you have any Fitness to Practice information to declare?

yes no

(If yes, please enter details in box below)

Please tick the box I confirm that I have the right to work in the UK

Please tick the box I confirm that I am IR35 compliant and responsible for my own Tax and National Insurance contributions

Please tick the box I confirm that I have read and agreed to be bound by the terms & conditions