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Knock Medical Centre
General Practice in Mayo
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Our Team
Our Services
Primary Care
Women’s health
General
Midwifery Services
Men’s Health
Children’s Health & Wellbeing
Mental Health
Vaccine Services
Sickness Certificate
Patient Information
Appointments
Prescriptions
New Patients
Test Results
Medical Certification/Sick note
Fees
Resources
Contact Us
Patient Details Update
Repeat Prescriptions
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Repeat Prescriptions
Prescription (Repeat)
A form to apply for a repeat prescription
Name
First
Last
Address
*
Street Address
Address Line 2
City
County
Phone
*
Email
Date of Birth
*
DD slash MM slash YYYY
Prescription
*
DRUG NAME
DOSE
TIMES/DAY
Pharmacy
*
Colleran’s Pharmacy, Ballyhaunis
Curley’s Pharmacy, Ballyhaunis
Healthwest Pharmacy, Ballyhaunis
Life Pharmacy, Knock
Life Pharmacy, Kilkelly
Heneghans Pharmacy, Kiltimagh
Byrne’s Pharmacy, Kiltimagh
Davy’s Haven Pharmacy, Claremorris
Flynn’s Pharmacy, Claremorris
Boots Pharmacy, Claremorris
Lloyds Pharmacy, Claremorris
Other
Please select a pharmacy from the dropdown menu to which your prescription should be sent.
Please enter Other Pharmacy address
Prescription Fee - choose Private or GMS
*
Private €20
Medical Card (GMS) Holder €0
Medical Card Number
*
If you do not know your medical card number please call the HSE Medical Card information number on 1890 252 919
Credit/Debit Card
Card Details
Cardholder Name
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