Prescription Order Form

The prescription request form can be collected from reception or alternatively you can fill out the form below.

*Please ensure you list each medication you require

The charge for a repeat private prescription is €20.

It is your responsibility to ensure your prescriptions are renewed when you collect your last script from the pharmacy. Please place your order in sufficient time to ensure you do not run out of medication.

PLEASE NOTE: We do not accept requests for Repeat Prescriptions over the phone. Please complete this form by listing the items you require and submit. All Repeat Prescriptions take 72 hours (3 Days) to process.

Name*
First Last
Date of Birth*
Date Format: DD dash MM dash YYYY
Contact number*
Email*
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
By submitting this form, I agree to the cahernanemedical.com terms and conditions*
- Yes
Name
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: cahernanemed@eircom.net

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