Prescriptions will be sent directly to the pharmacy of your choosing.

Please indicate which pharmacy you would like us to send your prescription to.

(If not listed let us know and we can add it).

Please allow 48 hours for us to review and process your prescription request.

For Medical card holders and GP Visit card holders, there is no charge for repeat prescriptions.

For Private Patients, there is a €20 fee, paid in advance of the prescription being sent. You will be sent a link by SMS to make the payment online.

If you require a medication review by the doctor or blood tests for monitoring of certain medications, you will be requested to attend for review.

If you would like to pay online, please click here, or if you would like to pay over the phone, please call the practice on 093 70494.

Name

First Name

Last Name

Date of Birth

YYYY

If you have a Medical Card, please provide the card number

Phone

(###)

###

####

Email Address

Drug 1

Drug 2

Drug 3

Drug 4

Drug 5

Drug 6

Drug 7

Drug 8

Drug 9

Drug 10

Any other comments

Number of months required

Pharmacy selection

Which pharmacy will you collect your prescription from?

Pharmacy consent

I consent for my prescription to be sent to the selected pharmacy.