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*
Date Format: 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 >>
Comments
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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