Pharmacy First > Pharmacy First Request Pharmacy First Request EligibilityRequest a consultation with our pharmacist for common conditions under the NHS Pharmacy First service. Complete the form and our team will review your details and confirm your appointment.Are you registered with a GP in England(Required) Yes No ✕ Warning — Cannot Continue You cannot proceed at this time You must be registered with a GP in England to use the NHS Pharmacy First service. Patient DetailsFull Name(Required)Enter your full legal name.Date of Birth(Required) DD slash MM slash YYYY Required for pharmacy records.Email Address(Required) We will use this to confirm your appointment.Phone Number(Required)We may contact you to confirm your appointment.Address(Required) Street Address Address Line 2 City Post Code ConditionWhat condition do you need help with(Required)Earache (1–17 years)Sore throatSinusitisUrinary tract infection (women 16–64)ImpetigoInfected insect biteShinglesWhen did your symptoms start(Required)Today1 to 2 days ago3 to 5 days agoMore than 5 days agoBrief description of symptoms(Required)Describe your symptoms briefly.Safety ScreeningDo you have any of the following symptoms(Required) Severe pain High fever Difficulty breathing Rapidly spreading rash Facial swelling None of the above ✕ Warning — Cannot Continue Seek medical attention If your symptoms are severe or worsening, seek urgent medical attention. Our team will review your request as soon as possible. Do you have any medication allergies(Required) Yes No List your allergies(Required)List any medication allergies.Appointment RequestPreferred Appointment Date(Required) DD slash MM slash YYYY Select a preferred date to visit the pharmacy.Preferred Time of Day(Required) Morning Afternoon Anytime GP Details and ConsentGP Practice NameEnter the name of your GP surgery if known.GP Practice PostcodeEnter the postcode of your GP surgery if known.Consent to contact my GP if needed(Required) Yes No I consent to the pharmacy contacting my GP practice if needed to support my consultation. ! Warning — Please Read GP notification recommended We recommend informing your GP for continuity of care. A clinician may discuss this with you. DeclarationsInformation Accuracy(Required) I confirm my information is accuratePlease ensure all details are correct before submitting.Pharmacy First Consultation Consent(Required) I consent to this consultationI consent to the pharmacy reviewing my information to provide advice and treatment under the NHS Pharmacy First service where appropriate.Privacy Policy(Required) I agree to the Privacy PolicyPlease review how we collect, use and protect your personal data.CAPTCHA What to expect Complete this form so our pharmacist can review your symptoms before you visit the pharmacy for assessment and treatment, where appropriate.Confirmation email sent after submissionReviewed by our pharmacistPharmacy visit required if suitable Next steps 1Complete the consultation form 2Check your email for confirmation 3Our pharmacist reviews your symptoms 4Visit the pharmacy if appropriate