Please fill out the form to order your prescriptions.

Prescriptions require 72 hrs notice.

Some prescriptions will incur a fee. If this applies to your prescription you will receive an email with details of the required payment.

Prescription

Your First Name *

Your Last Name *

Your Phone Number *

Your Email *

If you are a private patient do you consent to receiving a payment request by text?

Yes

Patient’s First Name *

Patient’s Last Name *

Patient’s Date of Birth *

Patient’s Address *

Please advise which prescriptions you would like to order allowing one line per item.
If you want to add prescriptions for a second patient, please select second patient below.

Which Prescription do you want to order? *

Do you want to order a prescription for a second patient?

Yes

Second Patient’s First Name *

Second Patient’s Last Name *

Second Patient’s Date of Birth *

Second Patient’s address if not the same as the first patient

Which prescriptions do you want to order for the second patient? *

Select the pharmacy you want to collect your prescription from * Select the pharmacy you want to collect your prescription from

Wallace’s Pharmacy,
Ballyvolane Shopping Centre,
Ballyvolane, Cork

Carrignavar Pharmacy
Unit 3&4
Main St Carrignavar
Co. Cork

Glenheights Pharmacy,
4 College Shopping Centre,
Ballyvolane, Cork

Blackpool Late Night Pharmacy,
34 Watercourse Rd, Blackpool,
Cork, T23 PRH6

Sam McCauley’s Blackpool,
Unit 15/ 17,
Blackpool Shopping Centre, Cork

Boots Blackpool,
Blackpool Retail Park,
Blackpool, Cork

Bourkes Pharmacy,
4A Iona Park,
Mayfield, Cork

Irwins Pharmacy,
Unit 1, Mayfield Shopping Centre,
Mayfield, Cork

Phelan’s Pharmacy,
Crestfield Centre,
Glanmire, Co Cork

Pharmacy First Plus Glanmire,
Hazelwood Rd, Riverstown,
Glanmire, Co. Cork

Owenacurra Pharmacy,
79 Main St, Midleton,
Co. Cork, P25 PY99

McElligott’s Pharmacy Blarney,
Ashdale House, Shean Lower,
Blarney, Co. Cork

Pharmacy First Plus Northside,
Glenwood Drive Cork

Hickey’s Pharmacy Mayfield,
Murray’s Supervalu,
Old Youghal Rd, Mayfield, Cork

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