Request a Repeat Prescription (Non-Medical Card Holders)

If you are aged between 17yrs and 30yrs and are ordering your REPEAT Contraception, please note there Is NO charge for this under the Government Free Contraception Scheme. To order your REPEAT contraception please click here

Please fill-out the form below. You will then be taken to Stripe to make payment.

We don’t see your credit card details at any stage.

Name*

First Last

Email*

Phone*

Date of Birth*

Medications

Medication	Dosage	Frequency	Actions

There are no Medications.

Preferred chemist for collection*

Length of Prescription*

Total Payment

Data Protection Policy*

I agree to the use of my mobile number and or email in keeping with the data protection policy of the Annascaul Health Centre

Please note that we ask for a minimum of 48 hours notice to process your request – prescriptions will be sent directly to the Chemist of your choice.

Phone

This field is for validation purposes and should be left unchanged.

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Request a Repeat Prescription (Non-Medical Card Holders)