Request Repeat Prescriptions with Gort Family Practice

Use the online form below to order your repeat prescription and please note:

This form is for repeat prescription requests only, any new medication will need to be discussed with your doctor during a consultation.
Allow 48 hours for us to process your request.
Your prescription will be sent directly to your pharmacy of choice, please specify if you would like to collect it from the surgery instead.
State the name of each drug on your repeat list and add the strength and dosage for each one.

First Name *

Last Name *

Date of Birth (DD/MM/YYYY) *

Email *

GMS Number (if applicable) (a €30 fee applies for private scripts)

Preferred pharmacy for us to send your prescription directly to:

Enter drug name, strength and dosage separated by a comma. Use a different box for each drug.

Drug 1 *

Drug 2

Drug 3

Drug 4

Drug 5

Drug 6

Drug 7

Drug 8

Drug 9

Drug 10

Drug 11

Drug 12

Drug 13

Drug 14

Drug 15

Your reorder will be defaulted to 6 months, however actual months given will be at the clinician's discretion.

Other Request

Please tick as appropriate:

A €30 fee applies to patients ordering private scripts.

Thank you for your order. Your order will be processed within 48 hours during office hours. We will be in touch regarding your payment if applicable and will send your order directly to your preferred pharmacy as indicated on your order form.

There was an error trying to send your message. Please try again later or contact us.

1. Click SEND below to send us your request.
2. Check your phone for a text message containing a payment link and make your €30 payment if applicable.