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Order Repeat Prescription
Full name of patient requiring prescription
Date of birth
Your doctor
- Select -
Doctor 1
Doctor 2
Doctor 3
Note that another doctor may prescribe your medication.
Telephone number
Email address
Does the patient have a medical card?
- Select -
No (€20 charge)
Yes (Free)
GMS Number
Does the patient have allergies?
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No
Yes
Please give details of any allergies
Name and location of preferred pharmacy
Requested Medications
Medication name
Dosage
Supply
Operations
Medication name
Dosage
Supply
Add medication
Consent to use your email address
I agree to the use of my email address and telephone number, in line with Cremore Clinic's data protection policy.
I consent to my data being used to prepare an electronic prescription.
This means your prescription can be digitally sent from your GP to your chosen pharmacy.
Submit Request
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