Health declarations

You can use the form at the bottom of this page to tell us about any health issues which may affect your fitness to practise; if you are a pharmacist or pharmacy technician already registered with us.

Please make sure that the information you give on the health declaration form is as accurate and detailed as possible.

You will need to let us know:

  • as much detail about your health condition as possible
  • how it affects your ability to practise as a pharmacy professional
  • what treatment or advice you have had, or are getting, for your condition
  • how you are managing the impact of the condition on your ability to work safely

You should also include

You may also want to include other supporting information, such as an occupational health report. (This is optional.)

You will be able to upload all these documents at the end of the web form below.

All of the above will help us to make a decision on how to deal with your declaration, and we shall be in touch to let you know about it.

Other declarations

If you are applying to join our register and have an issue which may affect your fitness to practise, follow this link to download and fill in the ‘Something to declare’ pdf form.

If you would like to declare other fitness to practise issues such as a caution, conviction or pending proceedings from another body, please go to: fitness to practise declarations.

Remember that, if you have already declared a matter as part of your application to the register or your annual renewal, you do not need to declare it again unless something has changed.

 

Health declaration form

This form is for pharmacists and pharmacy technicians already on our register. If you are applying to join our register and have an issue which may affect your fitness to practise, follow this link to download and fill in the ‘Something to declare’ pdf form.
Your details
Employer or training provider details
Please give us the contact details of your employer or training provider.
Your health condition
The effects of your condition
Please send us any relevant reports you may have received. You can upload copies of these at the end of the form
Modifying your practice
Details of treating doctors

Contact details of your GP

Contact details of your consultant (if you have one)

Contact details of your hospital (if relevant)