At Hickey's Pharmacy we can make getting your prescription easier.
Thank you. We have received your information. Your form has been forwarded to your selected Hickey’s pharmacy. When visiting the pharmacy please give your name to a staff member and let them know you completed the ‘EC form’ online. The pharmacist will then complete your EC consultation in the private consultation room. For contact details and directions to your selected pharmacy, please visit our store locator.
To save you time on your visit to Hickeys Pharmacy we have an online consultation form that can be completed in advance. When you arrive in the pharmacy, the pharmacist will have your form ready and will go through the various sections with you during a private consultation.
This service is open to women over the age of 17 years old. If you are under 17 please call the pharmacy to discuss your options.
This helps us to choose the correct product. One of the products can be taken up to 5 days (120 hours) after unprotected sex, but with all emergency contraceptives the sooner emergency contraception is taken the more effective it is.
This helps the pharmacist establish the risk of pregnancy. Leave blank if unknown.
Customers must attend in person to collect the morning after pill.
Emergency contraception can be taken more than once in a cycle, but the pharmacist needs to know this, so they can select the most appropriate product.
Some customers are on medication that could make the morning after pill less effective. The following questions help the pharmacist establish the best emergency contraception option for you:
Once you click submit your chosen pharmacy will receive your details. The pharmacist will review the information and prepare for your consultation. You must come to the pharmacy yourself. When you arrive in the store you can say that you emailed in an order and give your name. The pharmacist will go through the submitted form with you and advise you on the correct use of the chosen product.
I confirm that the information I have given is correct to the best of my knowledge. I am aware that I will need to attend the pharmacy in person and to speak with the pharmacist before emergency contraception will be supplied. I am aware that Hickey’s Pharmacies will retain this questionnaire for a period of two years in line with Data Protection Requirements.