Online Prescription Request

Cooper MediCare, Tralee operates a policy of accepting prescription request forms by written request only. This policy is strictly adhered to and our admin staff members are not permitted to accept verbal requests for medication at any time. This policy is in place to:

  • Ensure maximum patient safety.
  • Ensure that patients are aware of the medications they are requesting.
  • Reduce the risk of prescribing unnecessary medications.
  • Ensure accurate records of patient medication requests are retained.
  • Minimise human error.
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Online Prescription Request
Please complete the below form to request a Repeat Prescription.
Personal Details
Contact Details
Medical Details
Do you have a valid medical card or doctor visit card?


Please have your valid Doctor Visit Number or Medical card Number ready as it will be required to complete your prescription request.

Requested Medication

Please Complete For as Many Medications You Need

  • Medication Name
  • Dose (in mg)
  • Quantity of Medication Required
  • Frequency (how often do you take this medication? e.g. twice daily )
Medical/GP Card Number
Payment
€ [field45]
Stripe Card Placeholder
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Your prescription will be forwarded to your nominated pharmacy and will be ready for collection at the pharmacy within 2-3 working days. Please do not attend the surgery to collect your prescription.

Should you wish to download a printable form please click here and return the completed form to us by post.