Pharmacist Registration Form

Why do we need this information?

In order to set you up with a Healthmail account we need to ensure you are a supervising pharmacist working in a pharmacy. The information you provide will be authenticated by the Irish Pharmacy Union. We need your existing email account and mobile phone number so that we can send you a username for your new Healthmail account by email and a password by text message.

Please Note: Your Pharmacy Name and City/Town will be used to create your Healthmail address e.g. Reilly's Pharmacy, 11 Main St., Rathfarnham, Dublin 14, will be reillys.rathfarnham@healthmail.ie.

Personal Details About your Pharmacy
Please use a mobile number accessible by the pharmacy.
E.g. 12345
E.g. (01) 123 4567
   
E.g. 12345
       
 
Current Email Address
 
Please use an email address accessible by the pharmacy.
Confirm Email Address (Current)

 

Terms & Conditions  
I agree that my information can be viewed by the Irish Pharmacy Union to authenticate me as eligible for a Healthmail account.