Anaphylaxis Treatment (Adrenaline Pens)

A licensed doctor reviews your answers before issuing this prescription.

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Prescription

Anaphylaxis Treatment (Adrenaline Pens)

€25 — reviewed by a licensed doctor before your prescription is issued.

Patient details

Patient full nameEmailPhone

Date of birth

Enter a date up to 17/10/2026.

PPS number (optional)

Needed on medical documents in your country. You can also fill it in on your profile later.

Preferred pharmacy (optional)

Type at least 2 characters to search.

My pharmacy is not listed

IE · Adrenaline auto-injector · Full

This form is for repeat prescriptions of adrenaline auto-injector pens (EpiPen, Jext, or Emerade) for a known severe allergy you've already been diagnosed with.

Your allergy

What are you allergic to, and roughly how many anaphylactic reactions have you had?

Have you ever been assessed by an allergy specialist for this?

How many in-date pens do you currently have?

Are you requesting one pen or two?

Have you ever actually used a pen for a real reaction?

Have you (or whoever might need to use this on your behalf) had training on how to use the device — for example with a trainer pen?

Height and weight

Height (cm)

Approximate weight (kg)

Your health

Do you also have asthma?

Are you currently taking a beta-blocker for blood pressure or a heart condition?

Do you have any heart disease?

How do you currently store your pens?

Do you carry a medical alert bracelet/card, and do you have a written allergy action plan from a specialist?

Patient address

Required for medical documents and any physical materials.

Street addressApt / unit (optional)CityEircode (optional)

Data sharing consent (GDPR)

I confirm the details above are accurate and consent to a video consultation with the selected clinician.I consent to my personal and medical data being processed by Global Health and shared with its treating clinics and medical network — including clinics in other countries — for the purpose of my care, service improvement, and security. Privacy PolicySend me appointment updates via WhatsApp (optional)