Pharmacy Registration

By completing the below registration form, you are automatically registered at Apotheek Skagerrak.

Any amendments or changes can also be communicated through the below registration form.

Please may we kindly ask you to complete a separate registration form per individual.

Your personal information is important to us and will be treated according to privacy regulations.

Address and Contact Details

Overview of Medication

Overview and control of medication is one of the most important responsibilities at Apotheek Skagerrak. Some medication might not be allowed to be taken together with some others or may not be applicable or appropriate for you personally That is why Apotheek Skagerrak needs to be informed of the entire current medication you are taking.

To ensure an optimal overview and control over your medication, please may we ask you to complete the following 4 statements:

Important Information / Remarks