NHS Electronic Prescription Service

Nominate Qrystal Pharmacy

Fill in this form and we'll register Qrystal as your nominated pharmacy on the NHS Spine. From your next prescription onwards, your repeat medication arrives at us automatically — ready for collection or free same-day delivery in London.

How nomination works

Takes about 3 minutes — no paperwork, no GP appointment.
Free for everyone. Standard NHS prescription charge applies per item unless you're exempt.
Change or cancel any time by asking another pharmacy or contacting us.
Your data is processed under the NHS Data Security and Protection Toolkit.

Patient details

TitleFirst nameLast name

Middle namePreferred name (if different)

Date of birth

SexNHS number (10 digits)

Mobile / phoneEmail

Address

Address line 1Address line 2 (optional)

Town / cityPostcode

GP surgery

Surgery nameSurgery address

Current pharmacy (optional)

If you’re currently nominated to another pharmacy, tell us so we can update the NHS Spine cleanly.

Current nominated pharmacyTheir address

Prescription charges

Do you pay NHS prescription charges?

Yes — I pay the standard charge per itemNo — I claim an exemption

Consent and signature

I confirm the details above are accurate and consent to Qrystal Pharmacy being nominated as my dispensing pharmacy on the NHS Spine. I understand I can change or cancel this nomination at any time, and that my data will be processed under the NHS Data Security and Protection Toolkit.

Signature (type your full name)

Date

8 June 2026

By submitting this form you agree to our handling of personal and health data for the purpose of NHS pharmacy nomination, in line with the Data Protection Act 2018, the UK GDPR, and the NHS Data Security and Protection Toolkit.