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Repeat Prescription Request

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Contact
How it Works
  • Please allow 2 working days for prescriptions to be completed.
  • Prescriptions are emailed digitally to your nominated pharmacy so there is no need to call the surgery
  • Repeat Prescriptions cost €30 (for Non-Medical Card Holders).
  • Most efficient way to request your prescriptions is via the online form below.
  • Prescriptions are not available in paper form / printed off form.
  • All patient data is securely processed. See our data privacy policy here.
  • All payments are securely processed by Stripe.
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Patients Full Name (Required)
Date of Birth - DD-MM-YYYY (Required)
Phone Number (Required)
Email Address
Home Address (Required)
GMS Number (If applicable)
GMS Expiry Date (If applicable)
Enter all allergies. If none, please write "None" (Required)
Name of regular doctor (Required)
Pharmacy (Required)
Medication
Paracetamol
Example Medication
50mg
Example Dose
3 times a day
Example Frequency
One week
Example Duration
Name of medication
Dose
Frequency
Duration
Name of medication
Dose
Frequency
Duration
Add Another Row
Make Payment

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