Nominate Ashton Pharmacy Now

I am the patient named above/carer of the patient named above. Nomination has been explained to me and I have also been offered a leaflet that explains nomination.*

I would like to nominate Ashton Pharmacy as my nominated pharmacy for dispensing prescriptions issued by the NHS Electronic Prescription Service*

I confirm that I have made my nomination of my own free will and have not been influenced or given a gift to select a particular nomination and that I can change my mind at a later date. *