Prescriptions

Order your prescription by completing the form on this page.

We operate a policy of accepting prescription request forms by written request only.

Please allow at least 10 working days for your prescription request to be processed by the doctor. The prescription will be sent directly to your specified pharmacy.

We recommend contacting the pharmacy in advance to check if your prescription is ready for collection.

Private prescriptions are subject to fees of €25. GMS patients and patients with Doctor Visit Cards will not be charged for prescriptions.

First Name *

Surname *

Date of Birth (yy/mm/dd) *

Phone Number *

Email *

Do you have a medical card, or DVC *

Yes

Name of your preferred pharmacy *

If Other, please enter pharmacy name and location

Please specify the medication that you require:

Medication & Dose (1) *

Medication & Dose (2)

Medication & Dose (3)

Medication & Dose (4)

Medication & Dose (5)

Medication & Dose (6)

Medication & Dose (7)

Medication & Dose (8)

Medication & Dose (9)

Medication & Dose (10)

Additional Notes

Upload your file here: If you need to submit documents/correspondence as part of this request please upload the file in PDF format.

Choose File

THANK YOU FOR YOUR PRESCRIPTION REQUEST. PLEASE ALLOW 10 WORKING DAYS TO PROCESS. THE PRESCRIPTION WILL BE SENT ELECTRONICALLY TO YOUR PHARMACY.

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