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New Patient Application

We are accepting applications from medical card and private patients; priority is being given to applications from patients living in the locality, those without a doctor in the area and individuals with increased medical needs.

 

Please complete the registration form below and we will contact you within 5-7 business days.  All new patients will be invited to attend the practice to complete registration. 

 

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.

 

Please note that adults must complete their own separate form to register, however children can be included on a parent's application. 

If you would prefer to submit this form in writing, please drop in to reception to collect a form. 

New Patient Registration

Birthday
Day
Month
Year
Do you have a medical card/doctor visit card?
Yes
No
Do you have other family members who wish to join the practice?
Yes
No
The practice would like to contact you by text message (SMS) regarding appointment reminders, test results and practice updates.
Yes, I consent to being contacted by SMS messages
No, I do not consent to being contacted by SMS messages

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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