New Customers

New Customer Registration

This form is for receiving regular ongoing supplies through the SecuriCare Home Delivery Service. If you only want one-off samples without joining our home delivery service, please visit our sister company, CliniMed.

Your Details

Account registration is only open to UK residents.

First name *

Surname *

Telephone *

Email * This will be your online account log-in name

Choose Password For Online Account * (minimum 6 characters) Remember to make a note of this!

Your address

Look up your address below. This will be used as your default delivery address (you can edit this and add additional addresses later).

Start with postcode / street *

Your Doctor’s Details

Doctor’s name *

Surgery name *

Surgery phone number *

New Customer Registration

Your Details

Your address

Your Doctor’s Details

Your area(s) of care

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