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Griffith Avenue Practice

Call us on: 01-8373611

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Repeat Prescription Request Form

Name

Email

Have You Visited The Dr in The Last 12 Months

Yes

No

Date of Birth

Mobile Number

Do You Have A Full Medical Card?

Yes

No

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 €15 Fee. This can be processed by phoning 01-8373611

Griffith Avenue Practice

Hours:

Monday* - Friday

09.00 - 12.00; 14.00 - 17.00

Outside these hours please call D Doc: 1850-224477

*Bank Holidays/ Public Holidays please call D Doc as above

01-8373611