Name * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email If you are not going to be in when we deliver your prescription, with your permission we can post it through your letterbox or leave your prescription in a safe location such as an outbuilding, garage, shed, enclosed porch etc. Alternatively we can leave your prescription with a neighbour. Simply tell us your preference in the box below. Thank you! Register with us and enjoy FREE delivery of NHS prescriptions