Nomination Request

Welcome to SEJ Pharma

Please complete the nomination request form below, if you wish to move your prescriptions to one of our branches.

Pharmacy

Select Pharmacy: *

Your Details

First Name: *

Middle Name:

Last Name: *

Address Line 1: *

Address Line 2:

City: *

County:

Postcode: *

Contact Number: *

Email Address: *

DOB: *

NHS No. (if known):

Tick here if you would like to be considered for our free delivery service.Note: this is only available at certain stores.

Tick here if you have or would like your medication in weekly blister packs Note: this is subject to us receiving 7 day prescriptions from your GP – one of our team members will be in contact to discuss this with you

Additional Person(s)

Please complete the sections below for any other household members who wish to register.

Full Name

DOB:

Full Name

DOB:

Full Name

DOB:

Full Name

DOB:

Quick Links

Home About Us Our Services OTC Lines Contact Us

Store Locations

Covingham Pharmacy Didcot Pharmacy Chinnor Pharmacy Whitton Corner Branch Great Wakering Pharmacy

Pharmacy Registration Information

Superintendent Name: Mitesh Aggarwal
GPHC Registration Number: 2074489

info@sejpharma.co.uk

Store Locations

SEJ Pharmaceutical Ltd, Unit 5a Caxton Trading Estate, Printing House Lane, Hayes, Middlesex, England, UB3 1BE

Company Reg No: 14359645
VAT No: 425563690

Email Address:

Email Address:

Nomination Request

Welcome to SEJ Pharma

Your Details

Additional Person(s) Please complete the sections below for any other household members who wish to register.

Quick Links

Store Locations

Pharmacy Registration Information

Store Locations

Additional Person(s)

Please complete the sections below for any other household members who wish to register.