Repeat Prescriptions

Repeat Prescription Request Form

Please ensure all information is accurate and matches your current prescription.

First Name *

Last Name *

Date of Birth *

Medical Card Number (if applicable)

Phone Number *

Email Address *

Pharmacy Name & Address *

Latest Readings (Required)*

Blood Pressure: ____/____ mmHg *

Heart Rate: ____ bpm *

Required For Patients Under 18

Weight *

Date of Readings *

IMPORTANT: These readings are essential for your prescription review. You can use readings taken at home with your own blood pressure monitor, or readings from a recent pharmacy or GP visit (within the last month). We cannot process your prescription renewal without these readings. If you don’t have a blood pressure monitor at home, many local pharmacies offer free blood pressure checks.

Drug 1

Name *

Strength *

Number of Repeats *

Drug 2

Name

Strength

Number of Repeats

Drug 3

Name

Strength

Number of Repeats

Drug 4

Name

Strength

Number of Repeats

Drug 5

Name

Strength

Number of Repeats

Terms & Conditions (You Must Agree)

I Agree With ALL Terms And Condition as listed below:

Your prescription will be ready for pickup at your pharmacy within 24 hours after we receive it, during business hours (Monday to Friday, 9 AM to 5 PM).
I explicitly consent to the processing of my health data for prescription management purposes.
I confirm it has not been more than 12 months since my last 30-minute zoom review appointment (required annually as per NICE guidelines).
I confirm there have been no significant changes to my medical history since my last review appointment.
Under-18 patients requiring parental consent.

Fee (1 month repeats): €0

Additional Fee (if any 3 months repeats): €0

Repeat Prescriptions