Patient RegistrationPlease complete the details below, and then inform us which services you would like to sign up for.Note: * indicates required information.Patient Contact DetailsName* Title Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Name Last Name Address* Street Address Address Line 2 City Postcode Date of Birth* Day Month Year Mobile NumberMobile Number Owner (if different)If the mobile number provided is not registered to the patient, please enter the name of the account holder and their relationship to the patient.Landline NumberContact Email Surgery DetailsSurgery name*My GP is Dr:Carer Details (if applicable)Are you registering for someone you care for?* Yes NoRelationship to patient*Carer Full Name:* Title Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Name Last Name Carer Address* Street Address Address Line 2 City Postcode Carer Mobile NoConsentI would like to register for the following services: (Please tick all that apply)Prescription Collection ServiceInstead of visiting the pharmacy with your prescription, we’ll collect directly from your GP surgery and prepare your medication. I authorise McPhersons Pharmacy to collect my prescriptions from my GP surgery on my behalf, either in person or via electronic transfer.Text Service ConsentYour personal and prescription details will never be shared outside McPhersons Pharmacy. SMS messages are generated using a secure facility but transmitted over a public network, which may not be secure. The pharmacy will not include any information in messages that could personally identify you. I consent to receiving SMS notifications when my prescription is ready. I will inform the pharmacy if my mobile number changes.McPhersons Pharmacy may contact you by SMS to notify you about your prescriptions, such as when it is ready for collection Under no circumstances will your phone number or prescription details be shared with any party outside McPhersons Pharmacy, and no details of your medication will be included in the text message. McPhersons Pharmacy will only text you in relation to your prescription and will not text you for any marketing purposes. This service does not offer a reply facility to enable patients to respond to texts directly.Express Collection LockerTo use our 24/7 Prescription Lockers, we need your mobile number to send a PIN when your prescription is ready. I consent to my prescriptions being stored in the locker and to receiving text messages. I will inform the pharmacy if my mobile number changes.Mobile Phone*As you have registered for a server that requires SMS please provide your mobile phone numberMobile Number Owner (if different)If the mobile number provided is not registered to the patient, please enter the name of the account holder and their relationship to the patient.Delivery ServiceDo you need a delivery service because you’re housebound? If yes, a member of our team will contact you to discuss.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.