Prescription order form

Our Pre-order Prescription service is a quick and convenient way to order prescriptions online from our website.

We’ll send you a text once your prescription is ready to collect. Please note Prescriptions are prepared during store opening hours – orders placed outside of opening hours will be prepared when we re-open. To check our store opening hours please see here.

Available in all Adrian Dunne Pharmacies this service can be used if you have a physical script, a script is held with the Adrian Dunne Pharmacy you are ordering from, or a script is being sent to us directly from a Healthcare professional. One off or repeat prescription can be ordered using the form below.

Please note that you will need to bring your original prescription with you if the prescription is not being sent directly to us by a Healthcare professional.

First Name ^*

Last Name ^*

Date of Birth ^*

Phone Number ^*

Email ^*

Address ^*

GP Name ^*

Do you have a Medical card, Drugs payment card, Long term illness card, or other card provided by the HSE?

Customer ^*

Requested Collection Date ^*

Choose a Store for Collection ^*

What is your prescription request? ^*

Your order details

Upload Script (Photo or Document) ^*

Max size: 2MB; Accepted file types: pdf, jpg, jpeg, png.

Do you need a claim receipt ^*
YesNo

By submitting this Prescription Request I agree to the Terms & Conditions and acknowledge the Privacy Policy for this service. I also acknowledge that my pharmacy needs the original prescription to legally dispense my medication. If I do not have this or my prescription is not on file, my pharmacy may not dispense my medication. I also acknowledge that the pharmacy may contact me if they have any queries about my prescription.

Prescription Order Form