Psychiatry Prescription Request

Step 1 of 2

Psychiatry Prescription Requests will be reviewed on the following dates :

Dr Mihaela Dima: Mondays and Wednesdays.

Dr Úrsula Casado:

July: 15th, 16th, 17th, 20th and 21st

August: 18th - 21st

September: 15th - 18th

If your treatment request is not accepted Dr.Online will refund you or schedule a follow up consultation with your assigned doctor.

Please select your doctor. *

Please select the doctor that is currently managing your case.

Name *

First

Last

Date of Birth *

Email *

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Select Pharmacy to where treatments should be sent. Select "other" if you can't find your pharmacy. *

County - Pharmacy Name and Address

Medication requested. *

On what day is your last tablet?

Last consultation date.

Next consultation date.

GDPR *

I authorize the collection and processing of my data, and I am aware that it will be handled securely and in accordance with the privacy policy at dronline.ie

In relation to the General Data Protection Regulation