Prescription Sign up Contact Details.Bensham Pharmacy181 Coatsworth RoadGatesheadNE8 1SQ Name * First Name Last Name Email Date of birth * MM DD YYYY Gender * Select Male Female Other Address Address 1 Address 2 City State/Province Zip/Postal Code Country Mobile number (###) ### #### Terms & Conditions * By using Bensham Pharmacy, you agree that Bensham Pharmacy will generate a nomination certificate using your electronic signature and personal details, which may be shared with your GP practice, Bensham Pharmacy or any authorised NHS or regulatory body. You give consent for Bensham Pharmacy to share information with your GP, if necessary, with regards to the electronic Repeat Dispensing Service (“RDS”). I agree Thank you for your submission.