Useful Forms

 

 

 

 

 

 

 

 

Medical Card Application Form.

Use this form to apply for a medical card or a doctor visit card. The form will need to be signed and stamped by your GP before you send it off.

We can do this without an appointment for any of our registered patients but you will need to allow us 24 hours as paperwork is a job that the doctors only get a chance to do after surgery has finished for the day. If you are a new patient applying for a Medical Card/Doctor Visit Card with us, you will need to have a quick chat with one of our GPs before we sign the form for you. There is no charge for this.

Medical Card Application Form.

Maternity Benefit Form - MB10

Use this form to apply for Maternity Benefit. It should be signed by your doctor and returned to the Maternity Benefit Section of the Department of Social Protection not less than 6 weeks before you intend to go on maternity leave.

Maternity Benefit Form - MB10

MED1 Form

Use this form to claim tax relief on all general medical expenses which are not covered by the State or by Private Heath Insurance (including dental expenses). You can only claim for medical expenses if you have receipts to prove your claim.

More details here...

MED1 Form

 

Drug Payment Scheme application form

Use this form to apply for a Drug Payment Scheme Card to assist you in paying for your medications if you do not have a full Medical Card.

Full details on the scheme are here...

Drug Payment Scheme application form

 

Driving Licence Forms.

From January 2013, The Road Safety Authority has taken over delivery of the driving licence and learner permit service. Full details on the NDLS website here.... Use the forms below in your application. Eyesight forms & Driving Licence medicals require a doctors appointment.

Driving Licence Application Form

Driving Licence Application Form - As Gaeilge

Driving Licence Eyesight Test Form

Driving Licence Eyesight Test Form - As Gaeilge

Driving Licence Medical Report Form

Driving Licence Medical Report Form - As Gaeilge

 

European Health Insurance Card - EHIC

The European Health Insurance Card (EHIC), formerly the E111, allows the holder to access health care services at no cost when travelling to or on holiday in another EU or EEA country. This is a great service and should be top of your list of things to get sorted if you're planning to travel abroad.

This is a free service and there is no charge for applying for the card. Any website which charges for either the application or the card is to be avoided. You can also apply online here... or download the form below.

EHIC application form

EHIC application form - As Gaeilge

 

Long Term Illness Scheme

If you are suffering from certain long-term conditions you should use the this form to apply for a long-term illness book which will ensure that you do not have to pay for drugs, medicines and medical appliances associated with the care and treatment of your condition.

The form will require a signature from your doctor.

Conditions covered by the Long-term Illness Scheme are:

  • Mental handicap
  • Mental illness (for people under 16 only)
  • Diabetes insipidus
  • Diabetes mellitus
  • Haemophilia
  • Cerebral palsy
  • Phenylketonuria
  • Epilepsy
  • Cystic fibrosis
  • Multiple sclerosis
  • Spina bifida
  • Muscular dystrophies
  • Hydrocephalus
  • Parkinsonism
  • Acute leukaemia
  • Conditions arising from use of Thalidomide

Long-Term Illness Scheme Form

 

 

 

Recent News

<< <  Page 2 of 12  > >>

GBMC on Facebook