New Patient

We are currently accepting a limited number of new patients.

Due to high demand, we regularly review our capacity for both private and medical card patients to determine when we are able to accept new registrations.

If you would like to join the practice, please complete the application form. We will review your application and contact you when there is availability.

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Gender(Required)

Occupation(Required)

Date of Birth(Required)

Phone Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City County EIRCODE

How long are you residing in Ireland?(Required)

If less than 12 months please state your previous address below:

Previous GP(Required)

Do you have(Required)

Medical Card

Doctor Visit Card

No Card

Medical or Doctor Visit card Number

PPS Number(Required)

Past Medical Issues(Required)

Medications(Required)

Next of Kin(Required)

First Last

Please tick to consent to receive text message/email communication from the surgery regarding results/administration. *

It’s ok to send me messages from the clinic from time to time

It’s ok to send information by email from the clinic from time to time

Comments

Please list if you have a family member in the clinic already and/or if you have been to our clinic before.

Do you have other family members who wish to join the practice?(Required)

If yes, please complete a separate application now for any additional family members hoping to join Tramore Medical Clinic.

Yes