Free Contraceptive Prescription Request
Request a free contraceptive prescription under the Free Contraception Scheme. Reviewed by a GP at Clanmaurice Medical Practice.
Eligibility
This service is available under the Free Contraception Scheme for women and people with a uterus aged 17–35 years who are ordinarily resident in Ireland and have a valid PPS number.
Important Safety Notice
This form is for prescription requests only. If you have chest pain, severe headache, visual disturbance, calf swelling/pain, shortness of breath, heavy bleeding, suspected pregnancy, or feel acutely unwell, please contact the practice urgently or seek urgent medical care.
Patient Details
Required to avail of the Free Contraception Scheme
Pharmacy Details
Prescription Details
All requests are reviewed by an Irish-registered GP. A prescription is not guaranteed — your GP may request additional information.
Clanmaurice Medical Practice · Abbeydorney 066 713 5525 · Ballyheigue 066 713 3200