Forms and Links

At Hazelhill Family Practice we like to make things as simple as possible for our patients.

That is why we have put together this section, which acts as a resource where you can access many of the most commonly used medical application forms and other helpful links.

To get the form you want, just click on it from the list below and you'll be able to download it straight to your computer.

Change of Doctor Form

Change of Doctor Form, for any patients who would like to attend Hazelhill Family Practice but are currently registered with another medical practice.

New Patient Registration Form

New Patient Registration Form for all new patients attending Hazelhill Family Practice.

Transfer of Medical Records

Transfer of Medical Records Form to permit transfer of patient medical records to Hazelhill Family Practice

GP Visit Card Under 6 Application Form

Application form to apply for a GP Visit Card for children under 6 years of age. This process is administered by the HSE. Details outlining how to submit your application are included on the form.

Medical Card/ GP Visit Card Application Form (MC1)

Medical Card/ GP Visit Card application form. This scheme is run by the HSE, details for how to submit your application are included on the form.

Medical Card/ GP Visit Card Over 70 Application Form (MC1(a))

Medical Card/ GP Visit Card -Over 70 Application Form (MC1(a)). This application is processed by the HSE.

Disability Allowance Application Form (DA1)

The Disability Allowance Application Form can be downloaded from the Hazelhill Family Practice website, for completion and submission to Social Welfare Services.

Domicilliary Care Allowance Application Form

The Domiciliary Care Allowance Application Form is available for download from the Hazelhill Family Practice website. Completed applications are returned and processed to Social Welfare Services.

Invalidity Pension Application Form (INV1)

The Invalidity Pension Application Form is available on the Hazelhill Family Practice website. Once completed forms should be sent to the Social Welfare Services (details listed at the end of the form).

Maternity Benefit Application Form (MB10)

The Maternity Benefit Application Form can be downloaded from the Hazelhill Family Practice website. Completed applications should be sent to the Department of Social Protection at the address listed on the form.

Driving Licence Medical Report Form (D501)

The Driving Licence Medical Report Form can be downloaded on the Hazelhill Family Practice website. We are happy to help any patients to complete this form, if required. Completed forms should be submitted to the National Driver Licence Service.

PIAB Medical Assessment Form

The PIAB Medical Assessment Form can be downloaded from the Hazelhill Family Practice website. The forms must be completed by a medical practitioner. Hazelhill Family Practice has extensive experience of assisting patients complete these PIAB Medical Assessment Forms.

Your Children's Immunisation -A Guide for Parents

Download the 'Your child's immunisation -A guide for parents' booklet from the Hazelhill Family Practice website. This HSE report provides detailed information about the immunisations provided for children from birth to 13 months. At Hazelhill Family Practice we can help provide any of the immunisations discussed in this guide.

Drugs Payment Scheme Application Form

The Drugs Payment Scheme Application Form is available for download from the Hazelhill Family Practice website. Completed applications are returned and processed to the applicant's local health office.