Thank you for your interest in applying to be a HRA-registered Pharmacy Assurance reviewer.

Please complete this form to tell us about your current employment and which research studies you are able to review through Pharmacy Assurance.

Pharmacy Assurance Reviewer Registration Form

Name –

Please give us the name you wish to be addressed by and, if different, the name you would like to be addressed by in official documents

Job title

Employing organisation –

Please include the work address to which any post could be sent if necessary.

Work email address –

Please provide a secure work email address that you access regularly and is not liable to become full.

Work contact telephone number –

Please provide a phone number on which you are happy to be contacted in work hours with voicemail which you will access regularly.

Line manager's name

Line manager's email address

Line manager's contact telephone number

Which studies will you review? – Please tick all that apply

What specialisms can you review? – Please tick all that apply

If you selected "other" as a specialism, what additional areas can you review?

General Pharmaceutical Council registration number –

Applicable for Pharmacist and Pharmacy Technician applicants in England, Scotland and Wales only

Pharmaceutical Society of Northern Ireland registration number –

Applicable for Pharmacist applicants in Northern Ireland only

Health and Care Professions Council registration number –

Applicable for Radiopharmaceutical Scientist applicants only