Repeat Prescriptions Online - Greystones Medical Centre

To request a repeat prescription, please complete the form below. It will be ready for collection at your nominated pharmacy within 2-3 working days. It is no longer possible to collect it from the surgery directly.

We can only accept repeat prescription requests via the online form below or alternatively, you may download a printable form instead and return the completed form to us by post.

If you qualify under the Free Contraception Scheme, please do not complete the form and call the Medical Centre on 01 287 4275 to arrange an appointment.

"*" indicates required fields

Step 1 of 3 - About You

First Name*

Last Name*

Address*

Town/City*

Phone*

Email*

Date of Birth*

Your GP*

Sorry, you must be a patient at Greystones Medical Centre to request a repeat prescription.

Do you have a valid medical/GP card?*

Yes

Does this prescription relate to Free Contraception Scheme?*

A fee of €20 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.

If you qualify under the Free Contraception Scheme, this form is not applicable, please call the Medical Centre on 01 287 4275 to arrange an appointment.

How Many Medications?*

Medication #1*

Medication #2*

Medication #3*

Medication #4*

Medication #5*

Medication #6*

Medication #7*

Medication #8*

Medication #9*

Medication #10*

Medication #11*

Medication #12*

Medication #13*

Medication #14*

Medication #15*

Medication #16*

Medication #17*

Medication #18*

Medication #19*

Medication #20*

Your Pharmacy*

Pharmacy Name*

Medical Card / GP Card Number*

We require a VALID valid medical or GP card number (no spaces) issued in your name.

Payment

A payment of €20 will be requested at the next step, please have your card details ready.

IMPORTANT: You must complete the payment after submitting the form as otherwise your prescription request will not be processed.

Repeat Prescription Fee*

Price:

Name

This field is for validation purposes and should be left unchanged.

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.

Please note, if you require a refund please call us on 01 287 4275.