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Register with Church Pharmacy

Please note: This website is for healthcare professionals only, including but not limited to doctors, dentists, nurses and pharmacists. Other qualified healthcare professionals who work in partnerships with prescribers‎ ‎who are listed on the hcpc-uk.co.uk site may also be considered depending on their qualifications and training.

General Information Please fill in all fields below.
* Profession
* Registration Number
e.g.: GMC, GDC, NMC etc...
* Title
* Gender
* Date of Birth
* First name
* Surname   
* Company name
Uploaded document size: should not exceed 5 MB per file. File specification: PDF/TIF/JPG/JPEG/PNG/TXT/BNP
Identification Details
* Please upload a valid photo ID document
For example, your passport or driving licence
Select files to upload
* Please upload an up to date proof of address document
Must be no older than 6 months and stating your current name and address.
Must be a utility bill/bank statement (financial info masked)/HMRC Correspondence
Select files to upload
Please note: In order to avoid delays in opening your account with Church Pharmacy, please ensure your name is listed on the professional registration body (i.e GMC/NMC), is the same as your photo ID and proof of address.
Qualification Details
Please upload any relevant certificates which you may hold covering the treatments you are looking to prescribe for and/or carry out such as Toxins, Threads, Dermal fillers, Chemical peels, etc.
Select files to upload
Insurance Details
Please upload any relevant insurance policies or certificates which you may be covered for relevant to the treatments you are looking to prescribe for and/or carry out.
Select files to upload
WORK DETAILS
Address Finder You can use address finder to search and automatically add an address or you can type the address directly into the fields manually. If the address finder can't find an address for you or if the address is a non-UK address, you will need to type it manually.
* Account Name/Clinic
* Address Line 1
Address Line 2
* Town/City
* County
* Post Code
* Country
* Landline Contact Number [The phone fields only save NUMERICAL data not letters or characters.]
* Mobile Contact Number [The phone fields only save NUMERICAL data not letters or characters.]
Please enter your mobile number without the country code (+44) or leading '0'. Example: "776XXXXXXX"
HOME/PERSONAL DETAILS
Address Finder You can use address finder to search and automatically add an address or you can type the address directly into the fields manually. If the address finder can't find an address for you or if the address is a non-UK address, you will need to type it manually.
* House Number/Name    
* Address Line 1    
Address Line 2
* Town/City   
* County   
* Post Code

* Country   
* Landline Contact Number    [The phone fields only save NUMERICAL data not letters or characters.]
* Mobile Contact Number [The phone fields only save NUMERICAL data not letters or characters.]
Please enter your mobile number without the country code (+44) or leading '0'. Example: "776XXXXXXX"


* Email Address   
* Invoice Address
Your Business Company Website Name e.g.www.example.co.uk
Your Business Social Media Accounts
* How did you hear about us?   
Login - Details
* Email
* Confirm Email   
* Password    Length between 6-20 - 1 upper case - 1 lower case - 1 digit - no space
* Confirm Password   
We will verify your registration details and contact you if we require any further information as soon as possible, typically within 2 working days if all information you have provided is satisfactory. Thank you