Service Portal : Lateral Flow Test Kits - Broadway Pharmacy with Cure Clinics

Make sure to have your NHS number ready before you enter your information below.

Your NHS number is a unique 10-digit number allocated to every patient in England, Wales, and the Isle of Man. Can’t find your NHS number? Locate it here.

Order Rapid Lateral Flow Tests

Please enter your information below to order your COVID-19 rapid lateral flow tests.

Information Sharing Consent(Required)

I consent to share my information

The Pharmacy will share the information on this form with: NHS England, to allow them to monitor how the service is provided by the pharmacy and to help evaluate the service; and The NHS Business Services Authority and NHS England to allow then the manage the contract the pharmacy has with the NHS, to make sure the pharmacy is paid correctly for the service and that they have provided the service properly. Broadway Pharmacy with Cure Clinics is committed to ensuring the security and protection of the personal information that we process, and to provide a compliant and consistent approach to data protection. If you have any questions related to our GDPR compliance, please contact our Data Protection Officer at contact@broadway-pharmacy.co.uk.

Patient's NHS Number(Required)

Patient's Name(Required)

First Last

Patient's Date of birth(Required)

Patient's Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

*Only fill out this section if collecting on behalf of the patient

Representative's Name

First Last

Representative's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

*Only fill out this section if collecting on behalf of the patient).

To be completed by the pharmacy team

Confirmation of eligibility(Required)

Patient letter seen

Clinical history assessment against eligibility

Date of supply(Required)

Batch/ lot number of LFD test kit supplied(Required)

*One box of 5 tests supplied.

Team Member Name(Required)