GMS Prescription Order Form

To order your repeat prescription, please fill out the form below.

Please place your order in sufficient time to ensure you do not run out of medication.
All Repeat Prescriptions take 72 hours (3 Days) to process.

"*" indicates required fields

Name*

First Last

Email*

Contact number*

Date of Birth*

Any known allergies?*

Details of Medications required*

Name of Drug

Strength of drug i.e. 5mg, 20mg etc

No. of tablets taken per day

To add more than one item, click the + icon

Contraceptive pill 'scripts require an appointment every 12 months. If it has been 12 months since your last pill 'script, do not proceed and contact us for an appointment.

We can only issue repeat scripts for medications which we have already prescribed. For new medication, do not proceed and contact us to make an appointment.

Please allow 72 hours for your prescription to be processed.

Your designated Pharmacy*

All prescriptions are sent to a pharmacy of choice.

I have read and agree with the Cahernane Medical Privacy Policy and consent to my submitted data being collected and stored**

Yes

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Phone

This field is for validation purposes and should be left unchanged.