Repeat Prescriptions

We operate a policy of accepting prescription request forms by written request. We also offer paper forms available for collection at reception. This policy is strictly adhered to and our admin staff members are not permitted to accept verbal requests for medication.

Prescriptions take 3 working days turnaround time.

Please follow up with your chosen pharmacy to ensure they have received this after 3 working days.

Repeat Prescription Online Order

(Once complete, continue to checkout to make payment)

€25

Order Repeat Prescription €25

Medical Card Holders / An Post / Garda Scheme

(Garda form needs to be completed)

No Charge

Repeat Prescription Online Order (No Charge)

Name

First Name

Last Name

Date of Birth

Email

Phone

(###)

###

####

Please Select

Prescription 1

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 2 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 3 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 4 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 5 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 6 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 7 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 8 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 9 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Prescription 10 (if applicable)

Please enter details: Name of drug / Dosage required / Number of repeats (1-6)

Additional information/additional medication (if applicable)

Pharmacy

We will send this prescription electronically to your nominated pharmacy.

Consent

I confirm I have received this medication (or these medications) from Wilton Clinic in the past 12 months and I confirm the request does not include a request for an antibiotic

Yes I consent