Weight Loss Injections - Erne Pharmacy

Weight Loss Injection Order Form

Please read our Guidelines for procedures & timelines

If requiring delivery, prescriptions can be emailed from prescriber(Advanced Electronic Signature) or posted. Please read prescription requirements below.
We can only accept an electronic prescription emailed, to medicines@ernepharmacy.co.uk, directly from your prescriber. It must include an Advanced Electronic Signature, this can be done via the SignatureRx/Sign.com/Docusign platforms.
If posting your prescription, we require the original ink signed prescription, we cannot accept photocopies or healthmail copies.
Postal prescriptions can take a number of days to arrive. We recommend express tracked delivery. As soon as your prescription arrives, we will contact you for payment.
Once you have completed the order form below, please proceed and send your prescription. We will only respond to this order form when we have received a valid prescription.
We can hold repeat prescriptions on file for your next supply. We require you to order your repeat medication, by completing a new order form, a week before requiring it.
If we already have prescription or it has been electronically sent, please allow us 2-3 days to respond to your order form.
Delivery is £15; this is a 24-hour (aim, not guaranteed) tracked delivery service, with temperature-controlled packaging. We post Monday – Thursday, once payment has been made please allow 2-3 days for us to dispatch.
Please post prescriptions to:

Erne Pharmacy,
12 Church Street,
Enniskillen
Co Fermanagh,
Northern Ireland,
BT74 7EJ

Order Request Form:

Order Type *

Title

Name on Prescription *

First

Last

Date of Birth *

Over 18 *

You must be over 18 years old to order weight loss injections

Email *

Mobile Number *

your Delivery Prescription

Medicines Required:

Select Medication *

Additional Strength

Please dispose of needles safely, using a sharps box

Please Tick if Required

Include Needles - £7.50
Sharps Box Required - £5.00
Alcohol wipes Required - £4.00

Postage (Tablets) £6.50 - 24 Hr Delivery (aim, not guaranteed)

Price: £6.50

We post Monday - Thursday

Total Amount

Item Quantity Qty Total

There are no products selected.

Select Medication - Mounjaro 2.5mg (Needles not included) 1 £170.00

Select Medication - Mounjaro 5.0mg (Needles not included) 1 £190.00

Select Medication - Mounjaro 7.5mg (Needles not included) 1 £250.00

Select Medication - Mounjaro 10.0mg (Needles not included) 1 £270.00

Select Medication - Mounjaro 12.5mg (Needles not included) 1 £310.00

Select Medication - Mounjaro 15.0mg (Needles not included) 1 £330.00

Select Medication - Wegovy 0.25mg (Includes 4mm Needles) 1 £115.00

Select Medication - Wegovy 0.5mg (Includes 4mm Needles) 1 £115.00

Select Medication - Wegovy 1.0mg (Includes 4mm Needles) 1 £115.00

Select Medication - Wegovy 1.7mg (Includes 4mm Needles) 1 £190.00

Select Medication - Wegovy 2.4mg (Includes 4mm Needles) 1 £220.00

Select Medication - Wegovy Tablets 1.5mg x30 1 £108.00

Select Medication - Wegovy Tablets 4.0mg x 30 1 £108.00

Select Medication - Wegovy Tablets 9.0mg x 30 1 £127.00

Select Medication - Wegovy Tablets 25mg x 30 1 £170.00

Select Medication - Foundayo(Orforglipron) 0.8mg x 30 1 £105.00

Select Medication - Foundayo(Orforglipron) 2.5mg x 30 1 £105.00

Select Medication - Foundayo(Orforglipron) 5.5mg x 30 1 £105.00

Select Medication - Foundayo(Orforglipron) 9.0mg x 30 1 £120.00

Select Medication - Foundayo(Orforglipron) 14.5mg x 30 1 £150.00

Select Medication - Foundayo(Orforglipron) 17.2mg x 30 1 £160.00

Additional Strength - No Selection 0 £0.00

Additional Strength - Mounjaro 2.5mg (Needles not included) 0 £0.00

Additional Strength - Mounjaro 5.0mg (Needles not included) 0 £0.00

Additional Strength - Mounjaro 7.5mg (Needles not included) 0 £0.00

Additional Strength - Mounjaro 10.0mg (Needles not included) 0 £0.00

Additional Strength - Mounjaro 12.5mg (Needles not included) 0 £0.00

Additional Strength - Mounjaro 15.0mg (Needles not included) 0 £0.00

Additional Strength - Wegovy 0.25mg (Includes 4mm Needles) 0 £0.00

Additional Strength - Wegovy 0.5mg (Includes 4mm Needles) 0 £0.00

Additional Strength - Wegovy 1.0mg (Includes 4mm Needles) 0 £0.00

Additional Strength - Wegovy 1.7mg (Includes 4mm Needles) 0 £0.00

Additional Strength - Wegovy 2.4mg (Includes 4mm Needles) 0 £0.00

Additional Strength - Wegovy Tablets 1.5mg x 30 0 £0.00

Additional Strength - Wegovy Tablets 4.0mg x 30 0 £0.00

Additional Strength - Wegovy Tablets 9.0mg x 30 0 £0.00

Additional Strength - Wegovy Tablets 25mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 0.8mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 2.5mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 5.5mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 9.0mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 14.5mg x 30 0 £0.00

Additional Strength - Foundayo(Orforglipron) 17.2mg x 30 0 £0.00

Please Tick if Required - Include Needles 1 £7.50

Please Tick if Required - Sharps Box Required 1 £5.00

Please Tick if Required - Alcohol wipes Required 1 £4.00

Postage (Injections) £15 - Temperature Controlled 24 Hr Delivery (aim, not guaranteed) 1 £15.00

Postage (Tablets) £6.50 - 24 Hr Delivery (aim, not guaranteed) 1 £6.50

Total £6.50

Additional Information

Please let us know any additional information.

If more then 4 weeks from your last supply from Erne Pharmacy or if you are a new patient can you include details: 1. strength currently taking; 2. how often taking dose; 3. has your strength been increased or decreased; 4. have you taken a break and restarting; 5. are you experiencing any side effects such as nausea, vomiting or abdominal pain.

Additional Information / Other Medications Orders *

Prescription Address

House Number/Name *

Street *

Town/City *

County *

Postcode *

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Weight Loss Injection Order Form

Please read our Guidelines for procedures & timelines

Medicines Required:

Additional Information

Prescription Address

Postage Address