Repeat Prescription Request

All regular medications should be requested, if possible, at the same time.

Do not order medication unless needed.

Please allow 48 hours for processing.

If you prefer, you can download and print this form and email it to info@oakwoodmedical.ie

Download Form

Repeat Prescriptions

Name

First Name

Last Name

Date of Birth

Address

Confirm Email

Confirm email address

Mobile Number

Mobile (in case we need to contact you to discuss your request).

Confirm Mobile Number

Confirm mobile number

Preferred Pharmacy

Prescription Request

Medication Name

Dose / Frequency

Repeat

Once Off

6 Months

12 Months

Add Medication Remove Medication

Have you attended for a medication review in the last 6 months?

Yes

Do you have any allergies to medications?

Yes

Allergies To Medications

Please outline any allergies you have to any medications

Additional Notes (Optional)

Our policy now is to email your prescription securely to your chemist of choice.
Please ensure that you have detailed your preferred chemist above.

I confirm that I request all of the above medications for my personal use.

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