Nuumad Sign Up

You can always press Enter⏎ to continue

Nuumad Sign Up

Please fill out and submit this form to sign up for the Nuumad platform.

11Questions

1
Membership Level
Please Select
Please Select
AviElite
AviPlus
AviStandard
2
Membership ID* This field is required.
3
Pharmacy Name* This field is required.
4
Post Code* This field is required.
5
Full Name* This field is required.
6
Email* This field is required.
7
Phone Number* This field is required.0xxxxxxxxx
8
Superintendents Name* This field is required.
9
Superintendents GPhC* This field is required.
10
Package or Bolt-on Required
Full-House
Altitude Sickness
Chicken Pox
COVID
Flu 25/26
HPV
Jet Lag
Meningitis ACWY
Men B
Period Delay
Pneumococcal
RSV
Shingles
Travel Health
Traveller's Diarrhoea
Vit B12
Weight Management
11
Total Cost (Excl. VAT)
Should be Empty:

Question Label

1 of 11See AllGo Back