Order A Repeat Prescription

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

Please allow up to 3 working days for prescriptions to be processed.

1 Step 1

First Name

Last Name

Address

0 /

Phone

Date of Birth

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

YesNo

A fee applies to private prescriptions. See cost breakdown below. We will contact you for payment once your request has been submitted. Thank you.

6 Month Prescription €30.00
3 Month Prescription €20.00
Once off Prescription €15.00
One Month Prescription €15.00

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

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.

Upload

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