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  • Main Street, Ballincollig, Co. Cork, P31 DA59

Online Payment*

Prescription Fee for Private Patients – €20 (not for holders of Medical Cards or GP Visit Cards)

*Required. If you are a private patient, you will need to pay €20 when ordering your prescription.  

Before filling the information below, you can pay the fee safely and securely using the form here. Once you make the payment, return to this screen and fill in your request below.

Once payment is made, fill the form below and click SEND.

If a payment is made in error, a credit will be left on your file.

**Non-payment will delay the processing of your request.**

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Please note:

    Your Details:

    Do you have a medical card?

    Do you have a Doctor Visit Card?

    Pharmacy Details:

    Medication Details:

    e.g.: Panadol

    500mg

    3 times daily

    2 tabs

    1 month

    Please Note:

    • Please allow 48 hours for request to be processed.

    • Patients may be asked to attend Dr for review depending on last attendance and current medications requiring monitoring.

    GDPR: We will only use the information you provide us in this form to deal specifically with your request for a repeat prescription and we will not use it for any other purpose.

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