We will use your mobile number to send you text messages to: 

• Tell you when your medication is ready for collection
• Ask you to contact us regarding any medication (and if we've not been able to speak with you)
• Update you on the availability of your medication 
• Arrange payment of your prescription if you pay (remember it is now £9.15 per Medication from 01/04/2020)

Please be reassured that we will not share your personal information nor contact you for marketing purposes. 

If you do not pay prescription charges please tell us why (tick the relevant option below).

The information I have given is correct and complete and I confirm proper entitlement to exemption.

I understand that if I falsely claim, I may be issued a Penalty Charge Notice, and I may have to pay up to £100 – as well as my prescription charge(s).

I understand that the NHS Business Services Authority may use and share my information within the NHS and with relevant Government bodies to check for fraud and mistakes.
Find out more at: www.nhsbsa.nhs.uk/yourinformation

I understand that:

• It is my responsibility to ensure my exemption details remain correct and in date
• I am required to inform Sarum Pharmacy of any changes to my telephone number and medical exemption including expiry

I confirm I wish to register with Sarum Pharmacy for Provision of my repeat medication and agree to be contacted by telephone/text message (please sign and date)