Please complete the following application form with as much information as possible. Please note that due to
current and increasing levels of clinical workload we unfortunately have a very limited capacity to accept new
patients. All decisions to accept a new patient will be made exclusively by practice partners. We endeavour to
make a decision on all applications as quickly as possible and will communicate the decision once one is made.
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Please note that at this time, all our GMS (General Medical Services) patient lists are at full capacity.
Unfortunately, the HSE has advised that we are unable to add any additional medical card patients to our lists
at this moment. We appreciate your understanding. If you require further assistance, please contact the HSE or
check their website for information on other available GP practices in your area.
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​Please note that all data received is processed in accordance with our strict data protection policy (available at
www.medicentre.ie) and GDPR guidelines. Information received from successful applications will be used to
create a medical record which will only be used for purposes pertaining to your medical care needs and will be
maintained in the strictest confidence. Information received from unsuccessful applications will not be held
and permanently deleted.
The practice would like to contact you by text message (SMS) regarding appointment reminders, test results and practice updates.
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.
