Prescriptions

Greystones Medical Centre operates a policy of accepting prescription request forms by written request only. This policy is strictly adhered to and our admin staff members are not permitted to accept verbal requests for medication at any time. This policy is in place to:

Ensure maximum patient safety.
Ensure that patients are aware of the medications they are requesting.
Reduce the risk of prescribing unnecessary medications.
Ensure accurate records of patient medication requests are retained.
Minimise human error.

Online Prescription Request

To request repeat prescription please complete the form below

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1 About you

2 Medications

3 Submit

Your Details

First Name

Last Name

Address

Phone

Date of Birth

Pharmacy name

Do you have a valid medical card or doctor visit card?

NoYes

A fee of €20 now applies to private prescriptions. Please have your debit or credit card details ready as payment will be required to complete your prescription request.

Please have your doctor visit or medical card number ready as it will be required to complete your prescription request.

Medications Required

If you have more than one item, simply start typing and further lines will appear as soon as the current one is completed.

#1 Medication

Dose

Quantity

Frequency

#2 Medication

#3 Medication

#4 Medication

#5 Medication

#6 Medication

#7 Medication

your full name

#8 Medication

#9 Medication

#10 Medication

#11 Medication

#12 Medication

#13 Medication

#14 Medication

#15 Medication

Payment

Please submit your payment details below

€ 20

Stripe Card Placeholder

Apply

GMS Card Number

Medical/GP Card Number

This form is secured with 256-bit encryption

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Your prescription will be forwarded to your nominated pharmacy and will be ready for collection at the pharmacy within 2-3 working days. Please do not attend the surgery to collect your prescription.

Should you wish to download a printable form please click here and return the completed form to Greystones Medical Centre by the following means:

Hand delivery: during opening hours – please place in Request Box at Reception;
Hand delivery: during closed hours – please post through the letterbox on the front door;
Post: please post to Greystones Medical Centre, Mill Rd, Greystones, Co. Wicklow.

Online Prescription Request

To request repeat prescription please complete the form below

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