Order Repeat Prescription

Repeat prescriptions may be issued for regular medication as prescribed by your doctor.

PLEASE ALLOW UP TO 48 HOURS FOR REQUESTS TO BE PROCESSED.

Please ensure you order your repeat prescription well in advance of running out of your medication to ensure treatment is continuous. It is important that you are regularly reviewed by the doctor if you are on medication to ensure it is working effectively and that you are not experiencing unwanted side effects.
Only order the items you need. If you have stopped taking any of your medicines, please tell your Doctor or Nurse.
If you have an emergency request, please contact our Reception Team directly and we will try to accommodate you.
This form is for repeat prescription ordering only. Please do not send urgent messages, diagnostic queries or clinical requests as they will not be seen by a doctor.
For prescriptions for acute illnesses/conditions, please contact the surgery by telephone as a GP will need to be consulted.

PLEASE ENTER YOUR REPEAT PRESCRIPTION DETAILS IN THE FIELDS BELOW

Name(Required)

First Name Surname

Date of Birth(Required)

Phone(Required)

Email(Required)

Prescription Type(Required)

No. of Months Required(Required)

Please note that the relevant fee may apply: 1 month €15.00 / 3 months €20 / 6 months €30

Items(Required)

Medication

List(Required)

Item

Dose

Quantity

Designated Pharmacy(Required)

Concent(Required)

I consent to my submitted data being collected and stored. Moville Surgery only uses this information for the purpose of providing repeat prescriptions and record keeping and does not share with any third parties.

By submitting this form, you are giving your consent for the practice to contact you by text message (SMS), telephone or email regarding prescription queries, reminders, test results and practice updates. We may also send you a text to advise that you need to contact the practice.

You will be sending personal/sensitive information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of contacting the practice.

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PLEASE ALLOW UP TO 48 HOURS FOR REQUESTS TO BE PROCESSED.

PLEASE ENTER YOUR REPEAT PRESCRIPTION DETAILS IN THE FIELDS BELOW

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