Some Useful Forms and Information

Below you will find lots of information and forms that may be of use.

Medical Card Application Forms

• Medical Card & GP Visit Card -  on-line

• Over 70's Medical Card and GP Visit Card application - MC1 Form

• Over 70’s Medical Card and GP Visit Card - on-line

• Under 8's Doctor Visit Card  - on-line

• Under 8's GP Visit Card - Registration Form 

• Change of GP Form (Medical Card & Doctor Visit Card patients only)

• European Health Insurance Card (EHIC) - on-line

Illness, Carer & Disability Benefit & Allowance Schemes

• Illness Benefit apply online - MyWelfare.ie

• Illness Benefit application IB1 Form.

• Long Term Illness (LTI) Scheme - Application Form

• Partial Capacity Benefit - Application Form 

• Carer's Benefit Application Form - CARB1 Form

• Carer's Support Grant Application Form - Form CSG1

• Disability Allowance Application Form - Form DA1

• Disablement Benefit or Incapacity Supplement Application Form - Form OB21 

• Domiciliary Care Allowance Application Form - Dom Care 1 Form

• Domiciliary Care Allowance Specialist Report - Dom Care 3 Form 

• Drugs Payment Scheme - Application Form

Maternity Benefits

• Maternity Benefit apply online - MyWelfare.ie

• Maternity Benefits Application - Form MB1

• Apply for additional 16 week Maternity Leave - Maternity Benefits Form

Tax Relief for Medical Expenses

• Claim tax relief for health expenses, apply online -Revenue on-line

• Claim tax relief for dental expenses MED 2 Form

• Prescription Charge Refund Form - PC1 Form

• Tax Relief for vehicles purchased / acquired for use by people with disabilities - Form DD1

• Claim for Fuel Grant in respect of fuel for drivers & passengers with disabilities - Form FG1

• Apply for Primary Medical Certificate - Local HSE Office 

• Apply for EU Parking Card via DDAI website - Apply online

GDPR  

The General Data Protection Regulation is a new law that comes into effect in Europe on 25th May 2018, it replaces previous Data Protection laws from 1998 and 2003.

This law governs how your personal data is stored, accessed, shared and processed. The law comes from the European Union and is complex, but in essence it regulates data controllers and provides rights to data subjects.

It is an important law and as a result we are implementing the necessary changes to ensure we are compliant with this law.

As your GP we are data controllers-which means we are responsible for important personal data that is held on file in the practice about you. Our practice has a Privacy Policy in place and this can be viewed below:

Practice Privacy Policy

 3rd Party Collection Consent Form

Pharmacy Collection Consent Form

Consent Cancellation Form

Access Request Form for patient files

New Patients

New patients can register with us by using the chatbot on our website.

If you have children with an under 8 Doctor Visit Card you will need to move their card to our list. Print the Change of Doctor form below, fill it in and return to our reception team to action.

Change of Doctor Form

Request for Notes from Previous GP Form