Repeat Prescription Form

BEDFORD MEDICAL CENTRE

Convent Rd., Athlumney, Navan, Co. Meath.

WWW.BEDFORDMEDICALCENTRE.IE

 

REPEAT PRESCRIPTIONS REQUEST FORM

(ALL REPEAT PRESCRIPTIONS MUST BE REQUESTED 48 HOURS IN ADVANCE)

THE PRESCRIPTION WILL BE READY FOR COLLECTION 2 WORKING DAYS (MONDAY TO FRIDAY) AFTER 2:30PM FROM DATE OF REQUEST. 

YOUR ORDER CAN BE: (1.) HANDED IN AT RECEPTION. (2.) SENT IN BY POST

 (3.) Via our website: www.bedfordmedicalcentre.ie

(4.) LEFT IN THE “PRESCRIPTION POST BOX” LOCATED BESIDE THE LIFT IN THE MAIN LOBBY ON GROUND FLOOR. (5.)ORDER IT VIA YOUR CHEMIST

 

DATE OF REQUEST: ____/_____/______    CHOICE OF CHEMIST:_______________________________________

 

YOUR FULL NAME: _______________________________TEL NUMBER: __________________       DATE OF BIRTH: ___ /____/______   

  

YOUR ADDRESS:___________________________________________________________________      

 

Please  list each medication in the rows here below: 

Name of medication required	Strength of medication	Number of times per day	1, 3 or 6 months