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QuickScript Pharmacist Application

Thank you for your interest in joining QuickScript's network of independent prescribing pharmacists. Please complete this application form to begin the vetting process. We empower prescribers with flexible, remote opportunities to deliver high-quality patient care.
Our application process involves:
1. Submitting this form.
2. Verification of credentials.
3. A brief onboarding discussion.
4. Access to the QuickScript Consultation Portal.

Personal & Professional Details

Full Name:

Email:

Phone Number:

GPhC Registration Number:

Are you an active GPhC-registered Independent Prescribing Pharmacist?

Are you an active GPhC-registered Independent Prescribing Pharmacist?

Do you hold valid professional indemnity insurance for independent prescribing?

Do you hold valid professional indemnity insurance for independent prescribing?

How many years of experience do you have as an Independent Prescribing Pharmacist?

Which minor conditions are you confident in prescribing for virtually? (Select all that apply)

Which minor conditions are you confident in prescribing for virtually? (Select all that apply)

What is your current employment status?

What is your current employment status?

Please describe your typical weekly availability for online consultations.

Agreements & Declaration

I agree to adhere to QuickScript's clinical governance protocols, safeguarding policies, and all relevant GPhC standards for remote prescribing.

I agree to adhere to QuickScript's clinical governance protocols, safeguarding policies, and all relevant GPhC standards for remote prescribing.

I have read and agree to QuickScript's Terms for Prescribers (including commission structure and responsibilities)

I have read and agree to QuickScript's Terms for Prescribers (including commission structure and responsibilities)

I understand and agree to QuickScript's data protection policies regarding patient information and will handle all data in compliance with GDPR

I understand and agree to QuickScript's data protection policies regarding patient information and will handle all data in compliance with GDPR

I declare that all information provided in this application is true and accurate to the best of my knowledge.

I declare that all information provided in this application is true and accurate to the best of my knowledge.