Patient Registration Form

Please complete the details below, and then inform us which services you would like to sign up for.

Your Preferred Pharmacy(Required)

My local Davidsons Chemist is:

Patient Contact Details

Name(Required)

Title First Name Last Name

Address(Required)

Street Address Address Line 2 City Postcode

D.O.B:(Required)

Email(Required)

Enter Email Confirm Email

Mobile No

Landline No

Surgery Details

Surgery Name

Carer Details (if applicable)

If registering for someone you care for:

Carer Full Name:

Title First Name Last Name

Carer Address

Street Address Address Line 2 City Postcode

Carer Mobile No

Consent

I would like to register for the following services: (Please tick all that apply)

Prescription Collection Service

Instead of visiting the pharmacy with your prescription - save time – we'll collect directly from your GP Surgery and prepare your medication, ready for your collection.

I authorise Davidsons Chemists to collect my prescriptions from my GP surgery on my behalf, whether in person or through electronic transfer.

Prescriptions Notification Service

You'll receive prompt text notifications when your medication is ready for pickup. Rest assured, your phone number and prescription details won't be shared with anyone outside Davidsons Chemists, and no medication details will be included in the text message.

I consent to receiving text messages regarding my medication.

I will notify the pharmacy of any mobile number changes.

Express Collection Locker (available in Arbroath, Banchory, Broughty Ferry, Milnathort & Scone)

Use our secure and convenient 24/7 Prescription Lockers, designed to store your prescription for easy and accessible collection. We'll need your mobile number for PIN notifications each time you have a prescription for uplift. Note that certain medications, like controlled drugs or bulky items, may not be suitable for locker collection.

I consent to making my prescriptions available in the locker.

I consent to receiving text messages regarding my medication.

I will notify the pharmacy of any mobile number changes.

Name

This field is for validation purposes and should be left unchanged.