Please fill out the form below with all your details so that we can send your repeat prescription to your nominated pharmacy. You can also upload an image of your prescription for your convenience.

(Please allow 3 working days for repeat prescriptions)

1 Step 1

First Name

Last Name

Address

0 /

Phone

Email

email

GP

Select An OptionDr Siobhan LynchDr Maureen RyanDr Kamsila Kennedy

Date of Birth

date_range

Do you have a valid medical card or doctor visit card?

YesNo

A fee of €20 applies to private prescriptions. We will contact you for payment once your request has been submitted. Thank you..

Please enter your Doctor visit or Medical card number below as it will be required to complete your prescription request.

Medical Card / GP Card Number

Medication

Name of Drug - Amount / Strengthe.g Paracetamol

0 / 200

Preferred Pharmacy

Select An OptionGrogans Pharmacy BallinaSean Collins Pharmacy BallinaSean Collins Pharmact KillaloeGreencross Pharmacy KillaloeAnna Kellys NenaghRyans Pharmacy Nenaghclare Street PharmacyGuerins Pharmacy NenaghRay Walsh Pharmacy NenaghFinnertys Pharmacy NenaghSlatterys Pharmact NenaghO'Meara's Pharmacy ScariffGreenCross Pharmacy CastleconnellSloans Pharmacy CastleconnellLloyds CastletroyOther (Please type Pharmacy name in the box below)

Pharmacy NamePlease type in the name of your preferred pharmacy if it is not in the list above.

Add PrescriptionSend us an image of your prescription.

cloud_uploadUpload

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I consent to having this website store my submitted information so they can respond to my inquiry.

Submit Prescription Request

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