The Crumlin Surgery
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HOW DO I....
Obtain A Repeat Prescription?

Requests should be made at least 48 hours before you require your prescriptions. Repeat prescriptions will be issued at the doctor’s discretion and are normally for patients on long-term treatment. Requests for prescriptions can be made in writing or by calling at the surgery between 9.00am - 1.00pm or 1.00 – 3.00pm Monday to Friday. We are unable to take orders or issue prescriptions at weekends, public holidays or out of normal surgery hours. Please allow two working days before collection and make allowances for weekends and public holidays. Where possible give exact drug names when ordering.

We do not accept any prescription over the telephone. This practice is non-dispensing. Please put your prescription request into the box located in the main foyer or, if after surgery opening hours, into the post box to the left of the main electronic doors.

THIS FORM BELOW IS CURRENTLY DISABLED - PLEASE USE ONE OF THE ALTERNATIVE METHODS MENTIONED ABOVE TO REQUEST PRESCRIPTIONS.

REPEAT PRESCRIPTION REQUEST FORM
* = Required field
First Names:
*
Last Name:
*
Date of Birth
(dd/mm/yyyy):
*
Email Address:
*
Phone Number:
 
Your Usual Doctor:
Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.
Drug Name
Strength
*
If you require more than 10 items, please submit another request.
Collection Point :
*
Comments:
(any comments that you may have about this service, or additional medication)

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above*