New Patient Registration

Shandon Medical Centre welcomes new patients. However from time to time, in the interest of maintaining an appropriate level of care for our patients, we may temporarily close our books. If you are interested in joining our practice, please complete the form below and we will be in touch.

Fees Useful Information

Please only fill out this form if requested. To query registration please email: admin@shandonmedicalcentre.ie

"*" indicates required fields

X/Twitter

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

Name*

Address*

Address Line 1 Address Line 2 City / Town County Eircode

Date of Birth*

Gender*

PPS Number*

Mobile Number

Landline Number

Previous/Current GP Name

Previous/Current GP Address

Address Line 1 Address Line 2 City / Town County / State Eircode / Postal Code Country

Medical Card/GP Visit Card Number

Private Health Insurance Provider Name and Policy Number

Medical History

Please outline any medical conditions you have been diagnosed with and current car you are receiving

Medications

Please detail the current medications you are taking

Allergies

Have you any allergies to medications you are aware of?