Patient Registration

We are now accepting New GMS/Doctor Visit Cards and Private patients to the practice. Please Apply below.

Registered Existing patients can update new contact details on the form below if required.

Home » New Patient Registration Clontarf

Patient Registration Details:

We are accepting a limited number of new GMS/DVC and non medical card patients to the practice, we review our panels monthly for free spaces.

Existing Patients

Please ensure to notify us if you move or change any of your personal details (e.g. address, surname, phone number) so that your records can be updated. Failure to do so could result in delays or prevent us from contacting you or a relative in an emergency.

Single Practice Registration Only

Please understand for continuity of care, patients must register with either Clontarf Family Practice or Fairview Medical Centre, and in doing so hospital reports will go back to the correct practice/doctor. It will not be possible to go between surgeries for ongoing medical care.

Expansion of Doctor Visit Cards:

The government recently announced:

The expansion of free GP care to all children under the age of 8 years and households earning below the median income threshold.

Disabled Patient Facilities

Disabled patient facilities are available at Fairview Medical Centre and Please let us know if you require any assistance.
(Car park space, toilet etc.)

Patient Registration Form
(Also for existing patients of the practice who wish to update contact details etc)

New Patient Information

We are delighted you are considering joining us. Because our community is growing quickly, we use a monthly waiting list system to manage new registrations safely.

Below is everything you need to know about joining our practice, booking appointments, and how we care for our patients.

Joining the Practice

Our clinical panels are reviewed every month to see how many spaces we can safely open up.

Category		Policy & Requirements
Who Can Apply		Local residents who do not currently have a GP. We accept Medical Card (GMS), Doctor Visit Card (DVC) , and private (non-medical card) patients who are new to the area.
Priority Access		Individuals and families who are brand new to the area and have no local doctor.
Proof Required		You will need to show proof of address (like a recent utility bill).
Your Previous Records		If accepted, we will need your previous GP’s details and your signed permission to transfer your medical history to us.
Family Applications		Immediate family (parents and dependents under 16) are kept together where possible. Children under 16 can be included on a parent’s form. Young adults over 16 must fill out their own form.
Important Note	Submitting an application form expresses your interest but does not automatically guarantee a place in the practice. To ensure safe patient care, our list is currently closed to local residents who already have a GP.

Practices & Policies

To help our clinic run smoothly and safely, we kindly ask you to note a few standard guidelines:

Area	Guidelines & Expectations
Booking Routine Appointments	Routine visits can book up to two weeks in advance. We recommend planning for regular check-ups.
Urgent & Emergency Care	We reserve a limited number of urgent, acute appointments every morning for sudden illnesses.
House Calls	Because our doctors need to be at the clinic to treat patients safely, home visits are reserved for exceptional circumstances and decided on a case-by-case basis.
Area	Guidelines & Expectations
Keeping Details Updated	If you move, change your phone number, or change your surname, please let us know immediately so we can reach you quickly in an emergency.
Choosing Your Surgery	To keep your medical history consistent, patients can only register with one of our practices either Clontarf Family Practice or Fairview Medical Centre, rather than moving between the two.
Honesty & Care	Great healthcare relies on trust. We ask that all registration forms are completely accurate. Providing incomplete information can impact the doctor-patient relationship and may result in a registration being cancelled.
Choice of Doctor	As Practice doctors work together, we cannot guarantee doctor of choice, however, we recommend patients request follow up appointment with the same doctor.
Our Front Desk Team	Our receptionists work incredibly hard to follow the guidelines set out by our medical management. Thank you for treating them with kindness and respect—they are unable to make individual exceptions to our rules.

Eligibility, Healthcare Schemes & Accessibility

Group / Scheme	Details & Support
Doctor Visit Cards (DVC)	Free GP care is available for all children under 8, and for households earning below the median income threshold.
Accessible Facilities	Fairview Medical Centre is fully equipped with accessible toilets and dedicated parking spaces. Please let us know if you need any assistance when you arrive!
Visitors from the EU	European Union visitors are entitled to free emergency care. Please present your valid European Health Insurance Card (EHIC) at reception before your consultation (valid in Ireland for up to 3 months).
International Patients	If you have private international health insurance, we will provide a full receipt at the time of your payment so you can claim money back from your provider.
Language Support	If you or a family member finds it difficult to speak English, we highly recommend bringing a fluent English-speaking friend or family member to act as a translator during your consultation. Please let us know at time of booking if you need language support.

🤝 Zero Tolerance Policy: Mutual Respect

We are fully committed to providing a safe, secure, and welcoming environment for everyone.

Kindness is Key: Our team works incredibly hard to care for you. We kindly ask that you treat our receptionists, nurses, and doctors with courtesy and respect.
Zero Tolerance: We operate a strict zero-tolerance policy towards any form of verbal abuse, aggression, threats, or discriminatory behaviour.
Our Response: Any individual who displays abusive behaviour towards our staff or other patients will be asked to leave the premises immediately and will be permanently removed from our practice panel.

New Patient Practice Registration / Update contact details if changed:
We are accepting a limited number of New GMS/DVC and Private Patients (please read important information above)

Step 1 of 3

Why do you wish to register with this practice? *

Please select why you wish to register with us.

Select Your Patient Type (or update your contact details) *

“Please select Patient application type from Dropdown list.

Patient Name *

First

Middle

Last

Patient's gender *

Todays Date *

Select todays date

Patient's Date of Birth *

Patient Landline Phone

Optional

Patient Mobile Number *

We require your mobile number in order to sent you SMS (text messages in relation to appointments etc)

Mobile Number Confirmation *

I confirm that my mobile number above is correct and I agree to receive SMS for the above purposes

Patient Email Address *

Confirm Email

This email address will be used to send you a confirmation when this form is sent.

Patient's Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

PPS Number

Your PPS number is required for the following services: Covid Vaccine, Covid Tel Consultations, Baby vac, Maternity care, Medical Card Data, Flu vaccines, Social Welfare Certs – without a PPS number standard fees may be applicable.

GMS/DVC Card Number

Enter your GMS/DVC Card Number

Health Insurance Number

Enter your Health Insurance Number if you have Health Insurance.

Insurance Provider

Select your current insurance provider

Option to add dependants under 16yrs old. (This is optional - to skip this section scroll to the bottom of the page and click 'NEXT' )

First name / Last Name, DOB, gender, PPS number and GMS/DVC number of whom you wish to register from your family e.g. any dependant under 16yrs old.

Note: Your spouse or dependents over 16yrs need to complete separate registration forms with their own consent.

Children (Under 16 Only)

Name (First Child under 16)

First

Last

Patient Date of Birth (First Child)

Patient's gender (First Child)

PPS Number (First Child)

GMS/DVC Card Number (First Child)

Enter the GMS/DVC Card Number for your first child

Name (Second Child under 16)

First

Last

Patient Date of Birth (Second Child)

Patient's gender (Second Child)

PPS Number (Second Child)

GMS/DVC Card Number (Second Child)

Enter the GMS/DVC Card Number for your second child

Name (Third Child under 16)

First

Last

Patient Date of Birth (Third Child)

Patient's gender (Third Child)

PPS Number (Third Child)

GMS/DVC Card Number (Third Child)

Enter the GMS/DVC Card Number for your third child

Consent

FOLLOWING APPROVAL: Consent for Myself/Family

I consent for my/our medical records for all of the above applicants and dependents under 16 yrs of age (to include summary of their medical history & active diagnosis) to be transferred to this practice. I also confirm that I have read and agree to the terms of the 'Consent for SMS Personal/Dependants for under 16yrs' notice (below).
I understand a follow up signed consent form will be required to send to my previous doctor for my medical records. This will be issued on approval. Ideally, the doctors will need these records prior to commencing services.

Previous GP Details & Consent

Name & Address of Doctor you would normally attend

Previous GP's Name *

First

Last

the Patient scroll

Previous GP's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Consent - (following approval) *

I consent for my/family medical records for all of the above applicants and dependents to be transferred to the practice. I also confimr that I have read and agree to the terms of the consent for SMS Personal/Dependants for under 16 yrs' notice below.
I understand a follow up signed consent form will be required to send to my previous GP for my medical records. This will be issued on approval to you by email. The doctors will need these records prior to commencing services.

Date / Time

Date

Time

Single Line Text

Note: Be sure to give consent above in order to submit the form – When the form is submitted sucessfully you will be taken to a confirmation page.

Data Protection and Privacy Statements

For information about our service and how your information may be used, please refer to our Data Protection and Privacy Statements, which is available via our website.

Consent for SMS Personal/Dependants < 16yrs

With your consent and provided your mobile number is correct we can now send you a free text message for the following purpose:

• Inform you & your dependants about results of your blood tests e.g. “results reported as normal or please contact the surgery to speak with your doctor” (please contact the surgery if you do not receive any texts within two weeks from your test date).
• Appointment reminders, Advise you about any changes to your appointment times.
• Remind you about vaccinations, and any other recalls necessary.
• Advice on administration queries for e.g. reminder about forms that are ready for collection
• Clinical results/data will never be exchanged via text message

To provide this service to you need to understand the above and agree to the practice communicating with you via text and to the following conditions:

• I agree to the practice communicating with me via short messaging service (SMS or text) for the above reason.

• I confirm that I will advise the Practice if I change my mobile number and understand that is my responsibility to do so.

• I confirm that I will notify the practice when my dependant reaches the age where they can operate independently

• I am aware that I can withdraw my consent at any time by informing the practice in writing and will need to give at least 5 working days’ notice

• Text messages are generated using a secure facility but I understand that they are transmitted over a public network onto a personal phone and as such may not be secure

This service is for healthcare notifications only not for correspondence. We will not receive any information returned by text.

I confirm that the mobile number entered in the from aboce is correct and is my number and agree to the above conditions.

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Phone

01 8331650



Email

[email protected]

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Clinic Hours

Mon-Friday 8:30am - 5.00pm

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Location

14 Kincora Avenue, Clontarf, Dublin 3, D03 T2W2

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Patient Registration

We are now accepting New GMS/Doctor Visit Cards and Private patients to the practice. Please Apply below.

Registered Existing patients can update new contact details on the form below if required.

Patient Registration Details:

Existing Patients

Single Practice Registration Only

Expansion of Doctor Visit Cards:

The government recently announced:

The expansion of free GP care to all children under the age of 8 years and households earning below the median income threshold.

Patient Registration Form (Also for existing patients of the practice who wish to update contact details etc)

Option to add dependants under 16yrs old. (This is optional - to skip this section scroll to the bottom of the page and click 'NEXT' )

Note: Your spouse or dependents over 16yrs need to complete separate registration forms with their own consent.

Children (Under 16 Only)

Consent

Previous GP Details & Consent

Data Protection and Privacy Statements

Consent for SMS Personal/Dependants < 16yrs

Phone

Email

Clinic Hours

Location

Patient Registration Form
(Also for existing patients of the practice who wish to update contact details etc)