Solas Medical -  Prescription Request 

Repeat prescriptions may be issued for regular medication as arranged by your doctor

Prescription requests will take 3 business days. We are unable to accommodate same day requests, except in emergency situations

Please ensure you order your repeat prescription well in advance of running out of your medication

Please note a fee of €20 may apply

This form is for repeat prescription ordering only. Please do not send urgent messages, diagnostic queries or clinical requests as they will not be seen by a doctor. Please call us on 01 494 3119

Full Name *
Address  *
Date of Birth *
MM
/
DD
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YYYY
Contact Number  *
Email 
Pharmacy *
1st Item Medication and Dose *
2nd Item Medication and Dose
3rd Item Medication and Dose
4th Item Medication and Dose
5th Item Medication and Dose 
Please include any further Medications and Dose here
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