Repeat Prescription Requests

This form is only for our existing patients.

You can use this form to request any repeat prescriptions from the Practice.

Please allow us 48 hours for the prescription to be sent to your pharmacy or for collection.

You'll get a text message when your prescription is ready for collection.

In case of private patient there is a repeat prescription fee.

Last Updated: 26/05/2023

Your Details

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

Medication Required

What medication do you require? *

Regular prescription

Other

If other, please write the name of the medication

Collection Details *

I have nominated a pharmacy and will arrange my collection from the pharmacy.

I wish to collect from the Practice

Nominated Pharmacy *

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the HSE. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

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Repeat Prescription Requests

Further Information