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Sign up to nominate Chelsea Green Pharmacy as your chosen pharmacy for medication dispensing in Chelsea, London.
If you have any questions, get in touch with us.
First Name *
Last Name *
Email *
Phone (Mobile) *
Address *
Postcode *
NHS Number
Date of birth *
Name of Surgery (please select) *—Please choose an option—Belgravia SurgeryHealth Partners at Violet MelchettKings Road Medical CentreKnightsbridge Medical CentreRoyal Hospital ChelseaStanhope Mews SurgeryThe Chelsea PracticeThe Good Practice
If not the patient, please specify your relationship
Are you exempt from paying? *—Please choose an option—YesNo
Upload proof of exemption (if applicable)
Please tick services required *I will collect my prescription in storeI would like to sign up for prescription delivery (subject to eligibility)
Signature *
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