NEW PATIENTS

We will email you once your registration has been completed

and you are set up on our system.

If you require an earlier appointment, please call 01 485 3258 once you have registered and we will arrange an appointment for you.

We are currently accepting new Medical Card and Doctor Visit Card patients.

If you require a GMS form to be completed, please bring it

into the clinic for Dr Hoban to sign.

Alternatively, you can apply for a Medical Card online through the HSE here.

New Patient Registration Form

First Name

Last Name

Date of Birth required

Address Line 1

Address Line 2

City

Eircode

Do you consent to being contacted by email?

Phone

Gender

PPS Number

If yes, please provde card number

Do you have Health Insurance?

Name of previous GP

Reason for Transfer?

Name of Emergency Contact

Relationship to you

Emergency Contact Phone Number

Notes

The above information is true to the best of my knowledge, and I wish to register as a patient with Hoban Health.

Thank you for your details. We will be in touch shortly.