Repeat Prescriptions :: thomondparkclinic

Repeat Prescriptions Request Form

Please fill out the form below.
Your prescription will be sent digitally to your nominated pharmacy.
Please allow up to 48 working hours for prescription requests to be processed. In case of emergencies, your pharmacy may provide a temporary supply. We recommend ordering repeat prescriptions early to avoid delays or disappointment, as all prescription requests are carefully reviewed, which takes time.
Repeat Prescriptions cost €20 for non-GMS card holders, we will call you to process payment
Prescriptions are not available in paper form / printed off form
Regular attendance with your GP is essential for ongoing prescriptions.

First Name

Surname

Date of Birth

Phone number

Nominated Pharmacy

Medical Card

Yes

Requested by

Name above

someone else- please state below

Prescription request made by

I wish to request

My Regular prescription

Other prescription

Medications requested including name, quantity & dosage

Medications not required from regular prescription

Date

By using this form you agree with the storage and handling of your data by this website

This service is for existing patients of the practice only