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Ballinasloe – Duane Pharmacy

In an attempt to minimize exposure during Covid-19 outbreak, we request patients contact us in advance so we may have prescriptions prepared to avoid groups of customers waiting together.

Please fill out the below form.

    Date of birth *
    (This service is open to women 18 years old and over. If you are under 18 please call any of our pharmacies to discuss your options (Note: under 18’s can still purchase the morning after pill from Healthwise Pharmacy, but must visit their local Healthwise Pharmacy first).

    If you have a medical card please enter your number here, alternatively you can bring your medical card with you to the pharmacy.

    Additional Information

    Time since unprotected sex

    Under 72 hrs72 - 120 hrsOver 120 hrs

    Is the medication for your own use?


    Is there any chance you may already be pregnant before this episode of unprotected sex?


    Have you used any form of emergency contraception since your last period?


    If so please list below:

    Are you breastfeeding?


    Other Medication

    Are you taking any other medication?


    Do you suffer from any illnesses, conditions or allergies (if so please list below)?


    If so please list below:


    090 964 2148

    Monday - Saturday

    9.30- 6.00 pm


    087 376 3252


    Society St, Ballinasloe, Galway, H53 P7D3


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