01 287 4275 | Out of Hours 01 453 9333

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 of 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

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

[[[["field14","contains"]],[["show_fields","field18,field17,field16,field15"]],"and"],[[["field18","contains"]],[["show_fields","field22,field21,field20,field19"]],"and"],[[["field22","contains"]],[["show_fields","field26,field25,field24,field23"]],"and"],[[["field26","contains"]],[["show_fields","field27,field30,field29,field28"]],"and"],[[["field30","contains"]],[["show_fields","field34,field33,field32,field31"]],"and"],[[["field34","contains"]],[["show_fields","field37,field36,field44,field35"]],"and"],[[["field37","contains"]],[["show_fields","field46,field45,field38,field43"]],"and"],[[["field46","contains"]],[["show_fields","field50,field49,field48,field47"]],"and"],[[["field50","contains"]],[["show_fields","field56,field55,field54,field53"]],"and"]]
1 Step 1
Prescription Order Form
First Name
Last Name
Address
Date of Birth
Phone Number
#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

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We aim to have all prescription requests reviewed within 2 working days.  Please do not attend the surgery to collect your prescription prior to this period.

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;
  • Fax – please fax to 01-287 4646;
  • E-mail – please e-mail to [email protected]