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  • Skin Care
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  • Seasonal Health
  • Sore Throat Test & Treat Scheme
  • Smoking Cessation
  • Travel Health Clinic
  • Travel Vaccination Service
  • Vaccination Service
  • Weight Loss
  • Women's Health
  • Skin
  • Acne
  • Aesthetics Service
  • Common Ailment NHS Scheme
  • Skin Care
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  • Sore Throat Test & Treat Scheme
  • Vaccinations
  • Travel Vaccination Service
  • Vaccination Service
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Trade account opening form

Fill out the form below and we will contact you within 48 hours once your account has been set up.

By submitting this form, you agree to the processing and storage of your personal information as set out in our Trade Account Privacy Policy. * Mandatory field

Your Details

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Date of Birth*

Professional in Charge

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Business Details

Business Address & Contact Details

Prescriber Details

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Do you require a prescriber?*
Who would you like to approve your prescriptions?*

Medical Profession Details

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Delivery Address

The delivery address is the same as the main business address*

Company Personnel

Purchasing Contact Details

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Accounts Contact Details

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Credentials

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Copy of Indemnity Insurance

Please make sure that the expiry date of your insurance is visable on the documents that you upload

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    • have a mix of upper and lower case characters
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    • have at least one ‘special’ character (such as space or punctuation)

Agreement

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Seren Plus. MHRA site number: 40635. GPHC registration: 1092601.
Registered address: 2 Castlegate Way, Dudley, DY1 4RH. Company House: 07767695. VAT: GB125263926.

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Registration Number: 10926012025 Health Plus Pharmacy. All rights reserved.