Ardee Family Practice
041 685 3205

WELCOME TO

ARDEE FAMILY PRACTICE

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NEW PATIENT?

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Prescriptions

Prescriptions

PLEASE NOTE; THIS FORM IS SOLELY FOR ORDERING REPEAT PRESCRIPTIONS. 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 OF YOUR USUAL MONTHLY PRESCRIPTION, PLEASE CONTACT THE SURGERY TO MAKE AN APPOINTMENT TO DISCUSS THIS.

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 €20.00

    We are now using the Billink payment service. You may be sent a text message from the practice with a link to allow you to  pay for your private prescription charge remotely. It is a safe & secure way to pay and you do not need to contact the practice as we are informed when payment is made. For any further enquires regarding Billink please contact the practice.