Registration

Registration For New patients

We Will Take Care of All Your Medical Needs

    Your Name*

    Surname*

    Phone*

    Your E-mail*

    Gender*

    Address*

    Street Address*

    Address-line 2
    City

    Eircode

    Date of Birth*

    PPS Number*

    Next of Kin Name

    Relationship to Patient

    Next of Kin Phone Number

    Do you have a medical card?*
    YesNo

    Do you have private health insurance?
    YesNo

    Name and address of previous GP*

    Name and DOB of any additional members who wish to register with us

    Do you have any allergies?*
    YesNo

    Do you consent to receiving communication from us through text message?*
    YesNo

    Consent*

    Where from did you hear about Clinic?



    Registering with the practice

    We are currently taking new patients : Medical Card (GMS) and Private Patients If you are interested in joining the practice, please leave your contact details with reception. When we are able to take on new patients, we will then advise you of this.


    Full medical check up:

    If you are joining the practice it is strongly recommended to arrange your first appointment for full medical check up. We would like to have more time to get to know you and plan your continuous care.

    If your medical history is not too extensive, you are healthy and do not feel you need a full medical check up, simply fill out the form and leave at the reception.

    Opening Hours