24-Hour Prescription Collection Registration

Join our 24-hour Prescription Collection Service

Complete this form to join our brand new, state-of-the-art 24-hour prescription collection service - granting you the flexibility to collect your prescriptions when it suits you; 24 hours a day, from our automated collection point at our Morpeth Pharmacy site.
Personal Information

We require your general contact information to confirm your identity and provide 24-hour prescription collection services to you, such as providing important email updates when necessary, and notifying you via text message when your prescription is ready to collect from the collection point.
Your Name*

TitleForenameSurname
Home Address*

Street Address

Street Address Line 2

Town/CityCounty (if applicable)

Post Code
Date of Birth*

DayMonthYear
Mobile Phone Number*

Country CodePhone Number
I consent for my mobile phone number to be used to contact me via SMS text messaging to inform me that my prescription is ready.*

I agree
Email Address*
example@example.com
I consent for my email to be used to contact me with essential news about the 24-hour collection service.*

I agree.
I would like to be emailed with the latest news, updates and health campaigns from Wellway Pharmacy Morpeth.

Select this box to opt-in to email updates.
Prescription Information

Please note you are required to inform us of your prescription exemption details to join our 24-hour prescription collection service. Wellway Pharmacy Limited will not be held liable for innaccuracies in your prescription exemption details based upon entries to this form. If your exemption status changes, you should inform us immediately.
Your GP Surgery*

Valens Medical PartnershipGreystoke SurgeryGas House Lane SurgeryThe Rothbury PracticeOther
Prescription Exemption Status*
This is your exemption status you fill out on the back of your prescription forms - if you do not pay for your prescriptions, you will have a specific exemption. If you pay for your prescriptions, select 'Not exempt - paying'.
Certificate Number
You have selected a prescription exemption which usually comes with a certificate and certificate number. Please state your certificate number here.
Certificate Expiry

DayMonthYear
Please confirm your registration.
I wish to join Wellway Pharmacy Morpeth's 24-hour prescription collection service. I agree that for any eligible prescriptions received physically or via the Electronic Prescription Service for myself, when Wellway Pharmacy Morpeth is my nominated pharmacy, that these prescriptions can be made accessible to me via the automated 24-hour collection point, and that I consent to be contacted by text message to inform me of this.*

I agree
Is Wellway Pharmacy Morpeth your nominated pharmacy?*
Please ensure Wellway Pharmacy Morpeth is your nominated pharmacy.

In order for us to receive your prescriptions to be dispensed, please ensure your nominated pharmacy is set to 'Morpeth Pharmacy' (FVK52). This can be done by: calling us on 01670 510 005, informing your GP practice of your change of nomination, or through the NHS app.
Today's Date*

DayMonthYear
How did you find out about us?

Existing patientThrough our websiteSocial media or online advertisingWord of mouth/recommendationOther
By submitting this form, you consent to Wellway Pharmacy Limited and our partner Jotform securely holding your data submitted for the purposes of registering you to our 24-hour collection point, nominating you to our pharmacy, and for use with any other pharmacy services you have opted into via this form.

As a patient at our pharmacy, we share limited information about you to those who commission our services, the wider NHS, and local and national authorities, for the purposes of providing healthcare and for our payments. You can read our full privacy statement at www.wellwaycentral.co.uk/privacy-policy.
Should be Empty:

Join our 24-hour Prescription Collection Service

Personal Information

Prescription Information

Please confirm your registration.

Please ensure Wellway Pharmacy Morpeth is your nominated pharmacy.