Nucare Pharmacy Norton Canes Key Worker Covid-19 Vaccination Registration Form

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Key Worker Registration For Covid-19 Vaccination

Please fill in the form below if you are a key worker

Getting your COVID-19 vaccination as soon as you can, will protect you and may help protect your family and those you care for.

With high rates of COVID-19, it’s more important than ever to help stop the spread of coronavirus, to avoid pressure on the NHS and to keep our workforce healthy.

Nucare Pharmacy has been commissioned to offer the COVID-19 vaccination.

You must be able to come to the site on short notice.

Please check your junk/spam mailbox for emails from Nucare Pharmacy Vaccination Centre.

Please enter your details below.

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Your email address

Your Postcode

The best phone number to reach you on

Your job role

Name of your employer

By ticking yes, you understand that vaccination notifications will be sent towards the end of the day at short notice. Completing this form does not guarantee receiving the vaccine. You are also consenting to being contacted for any future services.

I agree

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CONTACT

229 Victoria Road, Aston,
Birmingham
West Midlands
B6 5HP

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INFORMATION

Premises GPhC Number

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OPENING HOURS

BRANCHES

Nucare Pharmacy Aston

Nucare pharmacy, Cannock

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What is MHRA Shopping

Please select a branch to view orders, patients and history...

Website

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Order In

Patient Orders

Pending Orders

Complete Orders

Order History

Patients

Statistics

Configure

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What do you want to do?

Visit the website home page

Visit the website page for my pharmacy

Change my pharmacy

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Please provide your email address you use to login to your account, we will then send you a password reset code.

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The following list shows all the items you have placed orders for, click on an item to see all the dates you have placed an order for the item.

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Please provide a little more information to finish setting up your account...

Which of our stores you use

The surgery you are registered with

Are you registered for GP online services?

Are you exempt from prescription charges?

A contact telephone number

Your home address

Messages

No new messages

Online prescription ordering is not currently enabled for your branch. You can still store your items and set reminders to re-order.

Your recent prescription orders

What do you want to do?

Change User

Order

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Pharmacy

History

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Please enter your login details to access your account...

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Keep me logged in

Help! I have forgotten my password

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To keep your password secure you will periodically need to change it. Please provide a new password to login to your account.

New Password

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What do you want to change?

My Details

My Surgery

Prescription

Reminders

My Branch

My Health

Preferences

Dependents

GP Online

Password

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Select your local branch...

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Select this dependant as the current user

Create an account for this dependant so they can manage their account themselves

I no longer need to manage this dependants prescriptions and they will not be doing it themselves

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Add/Remove additional users who are dependant on you to place their orders for them...

Add a new dependant

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Yes

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Please provide us with a little information about your dependant...

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What is the dependants relation to you...

Parent

Child

Spouse/Partner

Sibling

I am their carer

Other

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What do you want to change?

Your Name

Contact Info

My Address

Exempt From Prescription Charges?

NHS Number

Gender

Date of Birth

Profile Picture

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Change your address...

Country

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I cannot find my address

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Change your contact information...

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If you have set your date of birth incorrectly, you can change it here...

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Are you exempt from prescription charges?

No, I pay for my prescriptions

Yes, For age related reasons

Yes, For medical related reasons

Yes, For benefits related reasons

Yes, For prepayment related reasons

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Select the reason you are exempt from prescription charges.

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Select your gender...

Male

Female

Other

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Change your names...

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Providing your NHS number will assist us dealing with your orders. However you do not have to provide this information if you do not wish to.

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When linking to online services would you like to store a copy of your prescription data so we can send you updates on your order

Yes Please

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When registering for online services with your GP you will have received a document containing the information required for the form below.

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Removing your connection to GP online services will delete all your prescription information. To re-register you will need to contact your surgery for new linkage information. This cannot be undone, are you sure you wish to continue?

Yes, unlink from GP online services

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Linking to your GP online will automatially manage your prescriptions based on information provided by your GP. If you would like to make use of this service then please contact your surgery. If you are already registered then please specify the provider of your GP online services.

I am not registered for GP online services

EMIS Patient Access

SystmOne

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What do you want to change?

My Health

Allergies

Chronic Conditions

Are you housebound?

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Please select which allergies apply to you...

Grass and tree pollen (Hay fever)

Dust mites

Animal dander, tiny flakes of skin or hair

Nuts

Certain fruits

Shellfish

Dairy products

Gluten

Insect bites and stings

Certain medicines and antibiotics

Latex (used to make some gloves and condoms)

Mould

Household chemicals (including those in detergents and hair dyes)

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Please select which conditions apply to you...

Acid Reflux

Arthritis

Asthma

Coeliac Disease

COPD

Diabetes Type 1

Diabetes Type 2

Eczema

Heart Disease

High Blood Pressure

High Cholesterol

Psoriasis

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Please let us know a little about you...

Use Metric Measurements

Please let us know a little about your health...

I am a smoker

I use a wheelchair

I am classed as vunerable by my doctor/surgery

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Please let us know if you are housebound

No, I am not housebound

Yes, I am housebound

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Please explain why you are housebound...

Other

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For security we will need you to provide your current password in order to change it.

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Change your preferences...

I would like to subscribe to updates and offers from my pharmacy

We will occasionally send you updates via email or push notification (if you have our app installed) with information from the pharmacy including changes to opening hours, changes to services, alerts for seasonal services (such as nhs flu vaccinations) public health warnings and pharmacy offers.

I would like to receive notifications on this device

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Setup the prescription items you would like to order...

Add an Item

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How many do you need?

Would you like to be reminded to reorder this?

I no longer need this

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Please search for the item you would like to add to your prescription...

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I don't need reminding

I would like reminding to order this item

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Mon

Tue

Wed

Thu

Fri

Sat

Sun

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You will need to order this now if you don't want to run out.

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Just this one time

Every 28 days

Every 56 days

Every 84 days

A different number of days

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Your recent prescription orders

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Configure your reminders to order your prescription items...

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Select the surgery you are registered with...

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Let us know who is going to be collecting your prescription for you.

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Select how you wish to receive your prescription.

Local delivery

Delivery via courier

I am housebound, I need it delivered

Free

I will collect it myself

Free

I will collect from a 24/7 collection machine

Free

Somebody else will collect for me

Free

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Please let us know of any delivery instructions you need us to know about. You can just click 'Next' if there's nothing we need to know.

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Select the items you would like to order...

Change my prescriptions and set reminders...

Select All

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Please let us know the reason for you being housebound.

Other

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If you would like to leave a note to the pharmacy then add it here. You can just click 'Next' if there's nothing we need to know.

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Please confirm your order...

Your Pharmacy

Your Surgery

Your Prescription Items

Exempt From Prescription Charges

Delivery Address

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Please provide the password reset code we have emailed to you and a new password. Check your junk mail if you are unable to find the email!

Reset Code

New Password

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Check for updates from your surgery

Cancel this order

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Please provide an email and password to use to login to your account...

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Please provide a little information about yourself...

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Set your preferences...

I would like to subscribe to updates and offers from my pharmacy

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Before creating an account you must agree to our privacy policy

I agree to the privacy policy

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Your shopping orders

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Cancel this order

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Did you know?

You can quickly move between your user dashboard for ordering and managing prescriptions and our pharmacy website.

Simply swipe the screen with your finger to the side to switch.

Don't show this again

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Things looking a little different?

We have updated your user dashboard to simplify and improve your experience. We hope you like it.

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If you are managing prescriptions on behalf of somebody else you can add them into here and place orders for them by logging into your account.

Add a dependant user

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Logging in or registering for an account with us will allow you to order your prescription, keep track of the progress of your orders, setup reminders to place your orders and much more.

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