Prescription Order Form

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

Please note: the charge for a repeat private prescription is €20.
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.

Name*
First Last
Email*
Contact number*
Postal address*
Date of Birth*
DD dash MM dash YYYY
Any known allergies?*
List*
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
Your designated Pharmacy*

Please note: your script will be sent directly to your pharmacy.
I have read and agree with the Cahernane Medical Privacy Policy and consent to my submitted data being collected and stored**
- Yes
View our Privacy Policy here >>
Phone
This field is for validation purposes and should be left unchanged.

Cahernane Medical is located at 42 Cahernane Meadows, Muckross Road, Killarney

Cahernane Medical Centre,
42 Cahernane Meadows,
Muckross Road,
Killarney, Ireland V93 P6DE
Tel: 064 66 31716
Fax: 064 66 71677
Email: info@cahernanemedical.com

Name of Drug	Strength of drug i.e. 5mg, 20mg etc	No. of tablets taken per day