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Child Registration

  • In order to provide for your care we need to collect and keep information about you and your health in your personal medical record. Please complete the following form carefully.​
     

  • Our practices are consistent with the Medical Council guidelines and the privacy principles of the Data Protection Acts. For further details please see our Privacy Statement.​
     

  • Submitting this form does not guarantee acceptance to the practice.​
     

  • Please note that adults must complete their own separate form to register.​
     

  • If you would prefer to submit the form in writing, please contact reception for a form.
     

Do you have a medical card/doctor visit card?
Do you have private health insurance?

We advise all of our patients to check if you are eligible for Doctor Visit Card at:
https://www2.hse.ie/services/schemes-allowances/gp-visit-cards/gp-visit-card-8-to-69/

Childhood vaccines received and uptodate?
Are you allergic to penicillin?
Are you allergic to any medications?

The practice would like to contact you by text message (SMS) regarding appointment reminders, test results and practice updates. 

Do you consent to be contacted by text message?

By submitting this form you will be sending personal/sensitive information about yourself across the Internet. Please read our privacy statement​ to discover how we protect and manage your submitted data. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of contacting the practice.

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