Register your patient online

To help make things easier, you can complete the online registration form below if you have a patient you'd like to refer to the Medilink® service.

Alternatively, you can continue to email or call your local Medilink® Dispensing Care Team who will help set up your patient on to the Medilink® service.

Registering Nurse/HCP Details:

Full Name*
Job Title*
Hospital*
Telephone Number*
Email Address*

Patient Details:

Title (Mr, Mrs, Miss etc.)*
First Name*
Surname*
Address*
Postcode*
Email Address
Contact Telephone number*
Date of Birth (DD/MM/YYYY)*
NHS or CHI number*
If known, exempt from prescription fees?
Please select the preferred Medilink dispensing care centre*

Medilink Language Support Service:

Does your patient require the translation service for future Medilink calls or communications?
If YES, please select their preferred language:

Patient Medical Details:

Operation Type*
Is the condition*
Date of Operation, if known (DD/MM/YYYY)
Date of Hospital Discharge, if known (DD/MM/YYYY)

GP Details:

GP Name
GP Surgery Address*
Postcode*
Telephone number*

Products Required/Discharged with*:

Please note that we will automatically add the essential dry wipes and disposal bags with the order, unless otherwise requested.
Drug Tariff Product Code / Description Quantity
Any additional comments: (i.e. delivery instructions, when order is required or customisation/cutting requirements):
 
Man on the phone to Medilink Customer Services

Need support or advice?

If you need any further support or advice, then please contact Medilink® today. You can call us Monday to Saturday, from 9am to 5pm, on Freephone 0800 626388.

Contact us