Prescription Request | Griffith Avenue Practice

Repeat Prescription Request Form

Name

Have You Visited The Dr in The Last 12 Months

Yes

Date of Birth

Mobile Number

Do You Have A Full Medical Card?

Yes

Please Choose Your Pharmacy

Name of Pharmacy if Not Listed

Please Type List of Repeat Meds: Name/ Strength/ Frequency/ Amount

I agree to the use of my email/ phone nuber in keeping with the Data Protection Policy of Griffith Avenue Practice:View terms of use

Thank you. Your prescription request has been submitted.

This will be reviewed by a doctor and sent to your chosen pharmacy within 3 working days.

If there is an issue with the request you will be notified on the mobile number provided.

Please Note: Private prescription requests are subject to a €20 Fee. Once approved, you will receive a separate link to pay this fee Alternatively this can be processed by phoning 01-8373611