Repeat Prescriptions

Use this online form to order your repeat prescription and please note:

– This form should not be used for any other service.
– Please fill out all sections.
– Allow 48 hours for us to review and process your request, e.g order before 2pm today to collect after 2pm the day after tomorrow.
– State the name of each drug on your repeat list and add the strength and dosage for each one.
– Tick how many months you require before submitting.
– Please note that our admin hours are 9am-5pm on Monday/Tuesday/Thursday/Friday and 9am-11.30am on Wednesday.

SECTION A - REQUIRED

Name:

Date of Birth:

Email:

GMS Number (if applicable) (€25 fee for private prescriptions):

Preferred pharmacy for us to send your prescription directly to (a fee of €25 applies):

SECTION B - REQUIRED

Enter drug name, strength and dosage for each one. Select amount of months required at the end.

Select the number of months supply required:

SECTION C - REQUIRED

Please tick as appropriate:
I will collect my prescription from Pinegrove Medical Centre after 48 hours.
I will collect my medication from my chosen pharmacy after 48 hours.
I understand that a €25 fee applies for private scripts and consent to receive a text from Pinegrove Medical with a payment link.
I consent for a family member to collect my prescription or medication on my behalf.

SECTION D - OPTIONAL

This section only applies to fee paying patients who are paying €25 for a private prescription. Patients with a GMS Number can skip this section and go straight to the Submit button below.

Patients ordering a private prescription (€25), please complete Steps 1. and 2. below.
1. Click Submit below to send us your request.
2. Check your phone for a text message containing a payment link and make your €25 payment.