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Request Prescription

Please use this form to contact a branch to request a prescription.

About You

First Name *Required
Surname *Required
Date of Birth *Required
Phone Number *Required
Email Address *RequiredInvalid Email Address
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Your Address

Street Address *Required
Address Line 2
City
Postcode *Required

Your GP's Details

GP Name *Required
GP Surgery *Required

Your Pharmacy

Branch Selector *
Which pharmacy will deal with your prescription?
Required
Prescription Type *
Is your prescription paper or electronic?
Required
When will your GP surgery have your prescription ready *
Please add two working days from the day you ordered your prescription.
Required
How many items are on your prescription *
Please type any additional messages regarding your request below:

Prescription processing

When placing this order I acknowledge that my chosen O'Brien's Pharmacy branch will aim to supply my prescription within 72 hours of the time it is received from my GP surgery and that O'Brien's Pharmacy are reliant on my GP surgery to process my prescription in good time. I authorise O'Brien's Pharmacy to contact me by phone/SMS/email to make me aware of the progress of my prescription order.Please read and accept the terms.

Important Delivery Information

Due to the huge increase in delivery requests caused by the Coronavirus pandemic, we currently cannot guarantee we will deliver your prescription on any specified dates or times. Please bear this in mind when requesting a delivery. We will do our best to deliver when requested but please understand this may not be possible.Please read and accept the terms.