Ballincollig
Family Practice

New Patients
Please note, all new patients are required to complete the following forms: new patient registration form; data protection consent form (GDPR); request of medical records from previous GP form. Medical card patients must complete the form to switch their GMS doctor.  We cannot provide medical card until these forms are completed. Download a copy below.

• New patient registration form (all new patients)

  • Word document

  • PDF

• Data protection consent form (all new patients)

• Request of medical records from previous GP form (all new patients)

• Change of GMS doctor form (only for for medical card patients)

 

 

HSE Application Forms

• Medical cards

  • Medical card application form

  • Over 70s application form
     

• European Health Insurance Card - E111/EHIC

  • Download application form
     

• Long term illness benefit

  • Download application form 
     

• Drugs payment scheme

  • Download application form
     

• Disability allowance

  • Download application form
     

• Maternity benefit

  • Download application form

 

 

Driving Licence Medicals

• Medical report form D501

• Eyesight report form D502

• Medical Fitness to Drive Guidelines

• Patient advisory form

• Form