Printable Prescription Request Form
Post or Drop into Surgery Reception allowing 48 hours notice
BEDFORD MEDICAL CENTRE
Convent Rd., Athlumney, Navan, Co. Meath.
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 |
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