Please read the information below before placing your order:
– This form is for repeat prescriptions only. Any new medication will need to be discussed with your doctor during a consultation.
– Please allow 48-hours for processing your request. We are open Monday to Friday (excluding bank holidays). Any request received after 17h00 is processed on the next business day.
– Your prescription is sent electronically to your nominated pharmacy. Please advise if you would prefer to collect it from the surgery.
– Your re-order is defaulted to 6 months, however the actual months given is at the clinician’s discretion.
– A €20.00 fee is applied for all private prescriptions.

Repeat Prescriptions Form

First Name *

Last Name *

Date of Birth *

Email Address *

Mobile Number *

GMS Number

Nominated Pharmacy (including location) *

Enter the drug name, strength and dosage separated by a comma below. Use a separate box for each drug/item.

Drug 1 *

Drug 2

Drug 3

Drug 4

Drug 5

Drug 6

Drug 7

Drug 8

Drug 9

Drug 10

Drug 11

Drug 12

Drug 13

Drug 14

Drug 15

Any Other Info

Please tick:

Details *

I have completed all required details in full.

Private Prescriptions *

I acknowledge that a €20.00 fee applies to patients ordering private prescriptions.

To complete your request please click the SEND button below.

Thank you for your repeat prescription request. On processing your request, a link for any payment due is sent to your mobile phone. Please click on the link and follow the instructions to make payment.

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