Private 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.

"*" indicates required fields

Name*
DD dash MM dash YYYY
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.

There is a fee of €20 for all repeat prescriptions, a link will be sent to your mobile phone in order for you to make payment. This is a secure payment platform.

Please allow 72 hours for your prescription to be processed.
All prescriptions are sent to a pharmacy of choice.
I understand payment of €20 is due and I consent to receiving a payment link on my mobile phone*
I have read and agree with the Cahernane Medical Privacy Policy and consent to my submitted data being collected and stored**
This field is for validation purposes and should be left unchanged.