Repeat Prescription Request - Gorey Family Practice

There is a €20 charge for private patients. If you are a private patient and have not already paid this, please do so now via PayPal * There is no charge for patients who have a Medical/Doctor Visit (DV) / Under 6 card.

You will be brought back to this page after payment.

* Please note : using this option, you can simply pay by credit card – you do not need to have a PayPal account.

Repeat Prescription Payment *

I have a medical card - no payment needed
I am a private patient and have paid the €20 charge

PayPal Email address

If you paid using a PayPal account, please enter the email address of the PayPal account.

Patient's Name *

Address *

Date of Birth *

Phone Number *

Pharmacy Name *

Your prescription will be sent electronically to your nominated pharmacy. Please ensure that you include the address (town name) of your pharmacy

Medication(s) Requested (one per line) *

Medication 2

Medication 3

Medication 4

Medication 5

Medication 6

Medication 7

Medication 8

Medication 9

Medication 10

Additional information / additional medications

Choice of GP *

At Gorey Family Practice, we want to provide patient centred care. We ask patients to book with the same GP, if possible, for each appointment to allow the GP to get to know you and your health needs. Please tell us which GP you prefer to see by ticking one box.

If your GP of choice is unavailable and you need an appointment urgently we will book you in with an available doctor.

Data Protection *

By using this form you agree with the storage and handling of your data by this website. We value your privacy. You can learn about how we handle information by viewing our privacy policy.

All prescriptions are now issued directly to your nominated pharmacy and we will no longer be issuing paper prescriptions. Please allow 3 working days before contacting your pharmacy to arrange collection/delivery of your requested medication.

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