New Patient Registration

Use our form below to register as a new patient with us

If you would like to join the Practice please fill out the form below and a member of our admin staff will be in touch as soon as possible.

Please submit new patient requests to the surgery using the form below. A member of our staff will contact you in the coming weeks to confirm if the doctor has approved your application and if there are openings within our Collective GP panels. Once your request is accepted, you will need to schedule an appointment to visit the surgery and meet the doctor. During this visit, the doctor may recommend further assessments such as a well-person check, blood tests, ECG, or 24-hour blood pressure monitoring. Our reception team will inform you of the requirements for becoming a patient and will assist in managing any ongoing health concerns.

First Name

Surname

Date of Birth

Gender

Your Full Address

Phone

PPS Number

Do you have GP Visit Card/Medical Card?

Yes No

GP Visit Card / Medical Card Number

Do you have private health insurance?

Yes No

Private health insurance provider

Insurance Policy Number

Do you consent to receiving text message alerts from the Killarney Medical Centre ?

Yes No

Current GP

Do you consent to requested medical notes if accepted as a patient?

Yes No

Reason for leaving current doctor

Pharmacy

Medical History (Past & Present)

List of Medication if any

By ticking this box I confirm that I have read and accept the privacy statement and consent to being contacted by Killarney Medical Centre.

New Patient Registration

Use our form below to register as a new patient with us

If you would like to join the Practice please fill out the form below and a member of our admin staff will be in touch as soon as possible.

GP and Family Doctors Killarney,
47 Lower New Street, Killarney, Co. Kerry.

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