Add Additional branches within your group on one form?
You may add additional branches below by selecting "Click to add additional branch" (limited to a max. of 10 branches) or alternatively you may upload a branch list by selecting "Click to add branch list".
Premises to which the Solution(s), Services or Goods are to be provided
The agreement will apply to all branches added below (and shall form part of the same agreement)
(If there are no additional branches, please click Next)
Please download and complete this Branch Upload Spreadsheet. Then upload the spreadsheet below.
Solution(s) or Services to be provided – Fees collected quarterly by direct debit
FMD software includes:• Integrated FMD module licence within ProScript Connect• Remote support• FMD service requirement updates
Please note: The FMD service can only be pre-ordered if you are using, or have placed an order for ProScript Connect.
Solution(s), Service(s) and/or Goods – Charges
ProScript Connect FMD Service• Service activation with initial setup• Technical enablement FMD• FMD Service software e-learning module
Important service details
Please note if you have previously registered with an FMD provider, you as the user will need to contact SecurMed with your existing username & TAN code, requesting a change of MVS contact change. For more information on this please contact EHCP.
For this service to function, FMD compliant 2D barcode scanners will need to be purchased from EHCP. If you have not already purchased your scanners from EHCP please order above. It is the responsibility of the customer to ensure the correct number of scanners are purchased.
Additional Terms and Conditions
By executing this Order Form the Customer accepts that the provision of any Solution(s), Goods, and/or Services here-under by EHCP shall be subject to the terms of the existing Agreement which is in place between the parties (and which is subject to EHCP’s Master Terms and Conditions (the “Master Terms”) (a copy of which is available by following this link http://www.securepharm.co.uk/T&C/Rx Master Services Agreement.pdf)) and this Order Form is incorporated by reference into the Agreement.