starts here... - Chapelthorpe Medical Centre

Part 6
Patients (or their representatives) who don’t have to pay for their NHS
prescriptions must fill in this section. Please send proof of exemption by
providing photocopies of relevant documents to support any claim. If you are
exempt because you are over 60 or under 16 years of age, no proof of exemption
is required. Please call 0113 265 0222 if you need assistance.
The patient is exempt because he or she:
is named on a current HC2 charges
is 60 years of age or over
certificate
is under 16 years of age
gets income support
is 16, 17 or 18 and in full-time
gets income-based Jobseeker’s
education
allowance (JSA(IB))
has a maternity exemption certificate
is entitled to, or named on, a valid
has a medical exemption certificate
NHS Tax Credit Certificate
has a prescription prepayment
has a partner who gets Minimum
certificate
Income Guarantee (MIG)
has a war pension exemption
has a partner who gets Pension
certificate
Credit Guarantee Credit (PCGC)
Part 7
Declaration
I declare that the patient does not have to pay NHS prescription charges, is properly
entitled to exemption and that the information is true and complete. I further
declare that should the entitlement change, I will inform Pharmacy2U immediately
on 0113 265 0222, and I understand that if I do not do so appropriate action may
be taken.
I am the Patient
Patient’s Representative
Signature ..................................................................................... Date................................................
Name (printed) .........................................................................................................................................
Address (if different to overleaf) .............................................................................................................
Part 8
Frequently asked questions
Exemption from payment NHS Prescriptions
Application to take part in this service
I understand that the “Chapelthorpe Pharmacy” is the trading name of
“P2UChapelthorpe LLP” in which Chapelthorpe Medical Centre has a financial
interest, and wish to register for their use. I understand EPS nomination and
nominate Pharmacy2U to collect my prescriptions on my behalf either via EPS or
directly from my GP. I understand that by signing this form I give consent for my
prescriptions and information about my repeat medicines to be sent electronically
between my doctor and Pharmacy2U.
Signature..................................................................................... Date ..............................................
Please note - if you are exempt from prescription charges you will need to complete parts 6, 7 and 8.
Please tick here if you do not wish to receive marketing communications about
other Pharmacy2U products or services
©Pharmacy2U Ltd
Chapelthorpe_GPTakeOne_6pp_hassle_1013_4.indd 1-3
Why can I trust Chapelthorpe Pharmacy?
Chapelthorpe Pharmacy, in partnership with Pharmacy2U, provides
NHS prescription dispensing services and specialises in the home
delivery of medicines. Pharmacy2U currently serves hundreds of
thousands of UK patients. You can contact a pharmacist for help
and advice.
Who delivers my medicines?
Your medicines will be delivered by Royal Mail in plain, discreet
packaging. We will let you know when we despatch your medicines
by email, voice or text message.
What are the free of charge delivery options?
We can deliver to your home or any alternative address such as
your work, or to a carer.
What if I’m out when my delivery arrives?
You can tell us about a safe place to leave your parcel or Royal
Mail will leave it with your neighbour if they are in. If they still can’t
deliver, they will leave a card to let you know they have been. You
can then call to arrange redelivery for free.
Chapelthorpe Pharmacy
in partnership with
New service that will work with your doctor to
arrange and deliver your medicines
The end
of repeat
prescription
hassles
Can I still nominate Pharmacy2U if I have already
nominated another pharmacy?
Yes. The NHS EPS service allows you to nominate where your GP
sends your prescription at any time, making it more convenient for
you.
starts
here...
Register now and start benefitting
1
Simply fill in your registration form and return it in the
FREEPOST envelope provided, call us on 0113 265 0222
or visit www.pharmacy2u.co.uk/chapelthorpe
2
We’ll get in touch with your GP, then send you a welcome
letter to explain what happens next.
3
Then next time you need a repeat prescription call us on
0113 265 0222 or request it online - from then on we’ll
organise everything and deliver your medicines for FREE.
©Pharmacy2U Ltd
P2U JV-CHP-6P-1013
P2UCHAPEL
Register now to try the service
www.pharmacy2u.co.uk/chapelthorpe
Or call us today on
0113 265 0222
24/10/2013 09:13
Introducing the easy & fast way to get your NHS prescriptions
Chapelthorpe Pharmacy in partnership
with Pharmacy2U provides NHS dispensing
services. We will work with your doctor to
arrange and deliver your prescriptions for FREE!
Ordering and picking up your prescription
can be a real hassle - that’s why we have
introduced a new way for you to request your
prescription and
get hold of your
medicines, without
I do not have to arrange even having to
my work around
leave home!
going to Doctors and
pharmacy.
Simon Lyon
So easy, just pick up
the phone. No waiting
in surgery. No need to
leave the house.
You don’t have to worry about a thing!
©Pharmacy2U Ltd
1
FREE DELIVERY
Elizabeth Leech
REQUEST & DOCTOR
APPROVAL
3
DISPENSED BY TRAINED PHARMACY TEAM
1
2
3
It’s a brilliant service.
I can’t fault them
at all.
Chapelthorpe
Pharmacy
4
We will call you, or email if you prefer, when your
prescription is due - so you don’t ever have to worry
about running out.
Then we’ll request your prescription on your behalf
and obtain your doctor’s approval. You don’t even
have to leave the comfort of home.
Our trained pharmacy team will then dispense your
medicines, saving you the time and hassle of a trip to
the pharmacy.
And finally we’ll deliver your medicines to the address
of your choice - leave the hassle to us!
Register now to try the service
Complete the registration form opposite
Complete the registration form or call 0113 265 0222 or visit www.pharmacy2u.co.uk/chapelthorpe
Chapelthorpe_GPTakeOne_6pp_hassle_1013_4.indd 4-6
Patient’s details
Part 1
Mr/Mrs/Miss/Ms First Names ........................................................................................
Address ..............................................................................................................................
2
4
Please complete this form and return it freepost to: Chapelthorpe
Pharmacy, FREEPOST RLTU-BHYL-KEZJ, Leeds LS14 1PQ.
Surname ..............................................................................................................................
FREE REMINDER
Rita Poole
So whether you find it hard to get to the
pharmacy or can’t fit a trip to the doctors
into your busy schedule, there’s no need
to worry.
We will remind you by either email or
telephone before your medicines run out.
Alternatively you can call us or order online.
We will then request your prescription from
your doctor, dispense your medicines and
deliver them to your chosen address. Please
choose a delivery address where someone
will be there to receive the parcel - home,
work or a friend.
How it keeps working
Registration Form for the FREE NHS
repeat prescription delivery service
........................................................................ Postcode .....................................................
Date of Birth .....................................................................................................................
NHS Number .................................................
This can be found on the top of your
prescription under your name and address
Home Tel. No. ................................................................................................................
Work Tel. No. .......................................
Mobile No. ..............................................
Email Address ................................................................................................................
Please tick the relevant box
to indicate how you would prefer us to contact you.
Delivery Address (if different from above)
Part 2
Name ...................................................................................................................................
Address ...............................................................................................................................
........................................................................ Postcode ....................................................
Doctor’s details
Part 3
Surgery Name ....................................................................................................................
Address ...............................................................................................................................
Part 4
Free Reminder Service
Part 5
Payment details
Do you want us to contact you when it is time for your repeat prescription?
If YES, tick this box:
Please tell us when your next prescription will be needed D D / M M / Y Y
If you do not have to pay for your prescriptions, please go to part 6.
If you pay for your prescriptions, please give details of how you would like to pay:
Tick: Delta
Name on Card
Card No.
Start Date Visa
Mastercard
Maestro
Amex
M M / Y Y Exp. Date M M / Y Y Issue No.
©Pharmacy2U Ltd
24/10/2013 09:13