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Have your electronic prescriptions sent to RiteCare

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Electronic prescription nomination form

Complete this form to sign-up

Please complete this form to sign up to our prescription delivery service, ensuring that all the information is entered accurately. By filling in this form you are asking your doctor to send all your electronic prescriptions to RiteCare Pharmacy. You can change this nomination at any time.













    Upload proof of exemption (jpg, png or pdf)

    GP Name:

    GP Address:

    Do you wish to have your prescriptions dispensed into blisterpacks.

    By ticking this box you are consenting to your future prescriptions being sent electronically to RiteCare Pharmacy. We will then dispense your prescriptions and deliver them to you. You can change this nomination at any time.