Membership Registration

Registration - PillPods

Step 1 of 7

About you
I am setting up prescriptions for
- Just myself
- Myself and my family
- Person(s) I care for

Carer Details
Name
First Last
Contact Number
Contact Email
Enter Email Confirm Email
First Member
Name*
First Last
Date of birth*

DD
MM
YYYY
Gender*
Contact details
Email*
Enter Email Confirm Email
Phone

Add members
Type of Membership
Would you like to add a second adult member ?*
2nd Adult member
2nd Adult member*
First name Last name
2nd Adult date of birth*
Date Format: DD slash MM slash YYYY
2nd Adult Gender*
2nd Adult Phone
Children
Would you like to add a child to your membership ?*
Child 1
Child 1*
First name Last name
Child 1 date of birth*
Date Format: DD slash MM slash YYYY
Child 2
Child 2*
First name Last name
Child 2 date of birth*
Date Format: DD slash MM slash YYYY
Child 3
Child 3*
First name Last name
Child 3 date of birth*
Date Format: DD slash MM slash YYYY
Child 4
Child 4*
First name Last name
Child 4 date of birth*
Date Format: DD slash MM slash YYYY

Billing address
Address*
Address City / Town
Address 3 (optional)
County*
Eircode (optional)
Delivery address
Same as billing address*
- Yes
- No
Address*
Address 1 Address 2
Address 3 (optional)
County*
Eircode (optional)

Create Password
Enter a password so you can login to your account
Password*
Enter Password Confirm Password

Review Your Information
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Payment
Membership Number
Membership
Your card will be charged €2.99 now and will renew each month automatically.

You can cancel the renewal of your membership at any time in your account area.

You can also use your card to pay for orders placed for delivery.

You won't be charged for your prescriptions until they are being dispatched to you.
Credit Card

Membership is €2.99 per month
Consent*
I have read & agree to the Privacy Policy and Terms & Conditions
Prescription Requirement*
I understand that to order prescription medications for delivery, a prescription from a GP or online doctor must be sent to Healthwave. Prescriptions can be sent electronically by the doctor via Healthmail ePrescription or sent by post to us by you.

Your Membership

Free Delivery

Free Contraception

No Dispensing Fees

Pharmacist messaging

Total €2.99 per month