Repeat Prescriptions - Shandon Medical Centre

To order a repeat prescription, please fill in the form below. A prescription will be issued to the pharmacy of your choice. To ensure the quality of your ongoing care, the Doctor may ask you to attend an appointment to review your medication or contact you by telephone.

Repeat Prescription

Patient Details

Please fill out your patient details below before requesting a repeat prescription.
Full Name*
Date of Birth*
DD slash MM slash YYYY
Email*
Mobile Tel*
Prescription Details

You may request up to ten separate items, enter the name and the strength of each item on your prescription. Type Yes in the ‘Required’ column if you need the item this time and No if you do not require the item this time.

Please note that items will only be dispensed if they are included on your repeat prescription and a medication review is not pending
Pharmacy Details*
If your pharmacy has more than one branch, please specify, as well as phone or email if you have this information
Medication Name Quantity and/or Strength (i.e. 1mg a day)
Prescription Fee*
Total
€ 0.00
Email
This field is for validation purposes and should be left unchanged.

Medication Name	Quantity and/or Strength (i.e. 1mg a day)

Repeat Prescription

Patient Details

Prescription Details