NHSmail account registration form for Pharmacies, Optometrists and Dentists
Please provide evidence that you have completed the IG toolkit by sending an assessment report/certificate with your application (one is sufficient per practice). For further information see:
If information is missing from application form this may prevent us from creating account.
Part 1 – NHSMail Account Creation
1. Name: / 2. Role:3. Current ExistingEmail address:
4. Organisation name and address:
5. Organisation data service (ODS) code ** : / 6. Organisation telephone number:
7. *Pharmacists – GPhcregistration number:
*Optometrists – GOC registration number:
*Dentists – GDC registration number: / *Please note that we require your Organisation Data code and your professional registration number. If these are not completed form will be returned.
8. Does your organisation already hold any NHSmail accounts? Y/N / 9. If yes, please provide the email address/es:
All sites are limited to 3 accounts per site. 2 Individual Accounts and 1 Shared mailbox that will be named in a format that will be easily identified: company/StoreType.town/
Example :
10. Details of accounts required, full name and mobile number for each account owner:
11. Do you require a shared mailbox for your organisation? Please also confirm the account owner name and mobile number:
12. Reason accounts are required – what type of information will be exchanged and how frequently?
*For identification prior to new account passwords being confirmed
**ODS – the unique NHS allocated code for your organisation also known as NCAS code,
F-code or contractor code, (NB: you may need to contact your Head office to obtain).
Part 2 – NHSMail Sponsorship
As a sponsored user of NHSmail, I agree to abide by the NHSmail Acceptable Use Policy (AUP). If the AUP is breached or operational requirements dictate, North West CSU reserves the right to withdraw access to the NHSmail service.
Named of Individual on the Professional Register:
Date:
Signature:
Please email your completed form to
Further help
For any questions about your application or help with the process, please contact
It will be the responsibility of Store Manager to keep all details of stores individual named accounts, when staff members leave the organisation it will be the Store Managers responsibility to contact the Service Desk to mark staff as leavers. This will allow any additional staff members to have an account if necessary.
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