Ardee Family Practice
041 685 3205

WELCOME TO

ARDEE FAMILY PRACTICE

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Prescriptions

Prescriptions

PLEASE NOTE; Do not use this form to order medication that you have not been prescribed in the last 6 months. If you wish to order medication outside your usual monthly repeat prescription, you will need to speak to a Doctor first.

Please complete and submit

    Patient Name:
    Date of Birth:
    Address:
    Phone:
    Email:
    Medical Card No:
    Pharmacy:
    Current medication:

    Please allow a minimum of 5 working days for your prescription to be completed.

    All Private prescriptions are subject to a charge of €15.00