Dr. Adams Pharmacy

Register With Us

Registered Healthcare Professionals can register with us, using their professional council registration number.

Email Address *

Password *

Confirm Password *

Title

First Name *

Last Name *

Date of Birth

Gender

Phone Number *

VAT Number

Company / Clinic

Street Address *

City / Town *

Region (State, Country, or Borough)

Postal or Zip Code *

Country *

I am a registered prescriber

I would like to apply for MyRx Connect (for non-prescriber)

Profession *

Profession Registration Council *

Profession Registration Number *

Pin (6 digits) *

Signature *

Upload Passport / Driver's license / other governement-issued Photo ID *

Upload insurance document (Please submit the full aesthetic insurance document in PDF format, partial images or screenshots are not accepted.)*

Insurance document expiry date *

Upload your Aesthetics training certificate here *

Upload another Aesthetics training certificate here

Upload a third Aesthetics training certificate here

Upload Toxins training certificate here

How did you hear about us?

I confirm I have read and accept Dr. Adams Pharmacy's Terms & Conditions.