Registration form

Home/ Registration form

Name

Home address

Date of birth

PPS number

Email

Medical card/ DVC/ under 6 card number (if any)

Mobile Number

Current Medications ( + any drug allergies or previous allergies to vaccines)

Medical/ Surgical History

Previous GP

How did you hear about us?

I consent to the sharing of this medical information with the practice

Thanks for submitting your registration form to Kinsealy Medical Centre

Location

Kinsealy Medical Centre

20 The Rise

Melrose Park

Swords

Co Dublin

Contact us

Email:

(Patients)

(Health professionals)

kinsealymedicalcentre.gp@healthmail.ie

Phone:

Opening hours

Monday Friday 08.30-17.00

Saturday-Sunday Closed

Out of hours Contact

(D-Doc): 0818 22 44 76

Links

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