repeat Prescription Order

Order your repeat prescription here. Allow 24 hours for us to review and process your prescription request e.g order before 4pm today to collect after 4pm tomorrow from your chosen pharmacy. Office hours are from 8:30am to 5pm Monday to Friday excluding Bank Holidays.

State the name of each drug on your repeat list and add the strength and dosage for each one. Other comments to accompany your order should be made in our comments box at the bottom of the form.

Tick how many months you require before submitting.

Be sure to let us know your preferred pharmacy

For private scripts, we will contact you for payment before processing your order, if not paid online

Repeat Prescription Request Form

Name

First Name

Last Name

Date of Birth

YYYY

My Pharmacy Name & Address

Please add the name and first line of address of your preferred pharmacy so we can send your script directly

Email Address

Medical Card Number (if applicable)

Drug 1

Enter drug name, strength & dosage for each one. Select amount of months required at the end

Drug 2

Drug 3

Drug 4

Drug 5

Drug 6

Drug 7

Drug 8

Drug 9

Drug 10

Comments

Amount of Months Required

Click on amount of Months required

Checkbox

Please tick as appropriate

My repeat script will be sent directly to my chosen pharmacy and I can collect after 24 hour period has elapsed

repeat Prescription Order

OPENING HOURS

For on call
services
contact
Westdoc oN:

0818 360 000