Repeat Prescriptions

Please note:
– Use this form to order your repeat prescription only.
– Allow 48 hours for us to review and process your prescription request, e.g. order before 4pm today to collect after 4pm 2 days later.
– Script requests get processed during standard office hours between 9am & 5pm Monday to Friday except bank holidays.
– State the name of each drug on your repeat list and add the strength and dosage for each one.
– Ensure to complete all boxes on this form before clicking “Send”.

First Name *

Last Name *

Date of Birth (DD/MM/YYYY) *

Email *

Enter your GMS Number in the box below (if applicable). A €20 fee applies for private scripts unless you qualify under the Provision of Free Contraception Service scheme (if this is applicable enter your PPS number instead).

GMS Number

Preferred pharmacy for us to send your prescription directly to:

Other Pharmacy (if not listed above)

Enter drug name, strength and dosage separated by a comma. Use a different box for each drug.

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

Your reorder will be defaulted to 6 months, however actual months given will be at the clinician's discretion.

Other Request

Please tick as appropriate:

I am aware it may take up to 48 hours exc. weekends before I can collect from my chosen pharmacy as this depends on when my GP is next in the Practice.

I consent for family member to collect.

I am aware that a €30 fee applies to patients ordering private scripts and this should be prepaid at time of raising the order.

Thank you for your order. If applicable, you will be contacted by our administration team for payment. Upon receipt of payment your prescription will be processed. Allow 48 hours for it to be sent to your selected pharmacy.

There was an error trying to send your order. Please try again later.