South Dublin
info@briaspharmacy.com
Monday-Sunday 8:00 to 22:00
Emergency Call:
Patient Name :
Patient Surname :
Date of birth :
Address :
Eircode :
Phone :
PPS Number :
Do you have a GMS number ? YesNo
Please provide your GMS number :
Do you have a DPS number ? YesNo
Please provide your DPS number :
Do you have a LTI number ? YesNo
Please provide your LTI number :
Are you happy with the generic substitution? YesNo
When would you like to collect your prescription? —Please choose an option—Today ( 8 AM – 1 PM )This afternoon ( 2 PM -10 PM )Next working DayNext week
Please let us know if there are any special instructions for your prescription :
Would you like to keep your Prescription on file ? YesNo
Would you like us to refill your prescription each month and send you a text when it’s ready for collection? YesNo
Please Upload your Prescription here
How did you hear about us? —Please choose an option—TikTokInstagramFacebookXThreadsMeta AIYouTubeGoogleI spotted it from the streetRecommendation from othersMy doctor sent my prescription to youOther
By submitting this Prescription Request I agree to the terms and conditions for this service. I acknowledge that the pharmacy needs the original prescription to legally dispense my medication. If I don't have a valid prescription, the pharmacy may not dispense my medication. I acknowledge that the pharmacy may contact me if they have any queries about my prescription.
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Please bring the original prescription to the pharmacy, as we need it to legally dispense your medication.
