Sign-up application

Join The Big Health Community

Tell us about your business and the pharmacies you would like us to support. You can review everything before submitting.

1 Business

2 Contact

3 Pharmacies

4 Services

5 Billing

6 Review

Step 1 of 6 — Business

Tell us about your business

These are the details of the business entering into the agreement with The Big Health Community.

Legal business name *

Trading name

Business type *

Company number *

Registered / business address *

Town / city *

Postcode *

Main business telephone number *

Company website

Billing address is different from the address above

Billing address

Billing town / city

Billing postcode

Who should we contact?

This person will be our main authorised contact for the application and customer account.

First name *

Last name *

Job title / role *

Business email address *

Confirm business email address *Re-enter the main contact email address to help prevent typing errors.

Telephone number *

Use a different billing contact

Billing contact name

Billing email

Billing telephone

I confirm that I am authorised to submit this application on behalf of the business named above. *

Add your participating pharmacies

Add each pharmacy that you would like to include. You will choose the services for each location on the next step.

Choose the services for each pharmacy

Select one service tier and any applicable bolt-ons for every participating pharmacy.

When would you like to start?

Applications approved by 23:59 on the 23rd can normally begin on the 1st of the following month. Applications approved after this normally begin on the 1st of the month after next. Your requested start month is not confirmed until we approve the application.

Preferred start month *

Billing email *

Purchase order / billing reference (optional, if required by your business)

Estimated monthly service charge

Estimated monthly total
VAT is currently not charged.£0/month

No payment is taken when you submit this form.

Review your application

Check the details below before submitting.

Declarations

Please review the declarations in full before submitting your application.

View declarations in full

I confirm that the information provided in this application is accurate to the best of my knowledge.

I confirm that I am authorised to act on behalf of the business submitting this application.

I confirm that the NHS pharmacy profiles and public telephone numbers supplied for each pharmacy are current and accurate.

I confirm that each selected service is currently available, or is expected to be available, from the relevant participating pharmacy and that the pharmacy is appropriately authorised to provide it.

I agree to notify The Big Health Community of any closure, sale, transfer of ownership, insolvency, loss of control or other event that results in a participating pharmacy ceasing to operate under our business, and if any participating pharmacy withdraws from, is suspended from, or otherwise ceases to provide any NHS advanced service that The Big Health Community promotes on its behalf. Where reasonably foreseeable, notification must be provided at least 48 hours before the start of the next billing period. If reasonably foreseeable notice is provided less than 48 hours before the start of the next billing period, I understand that the forthcoming billing period may remain chargeable and the change will take effect from the following billing period. Where advance notification is not reasonably possible, I will notify The Big Health Community as soon as reasonably practicable.

I confirm that I have not included patient-identifiable information, clinical records or other patient health information in this application.

I understand that submitting this application does not itself activate a subscription. Services begin only after The Big Health Community has reviewed and confirmed the application and the required payment arrangements have been completed.

I confirm that I have read and agree to the declarations above. *

Your application is subject to our Privacy Notice. If approved, your final order summary and applicable Business Terms will be provided before payment and service activation.

Application received

Thank you. Your application has been submitted to The Big Health Community for review.

Application reference:

No payment has been taken. If the application is approved, we will contact you with your order summary and the next steps for payment and account activation.