Useful Forms

The following are forms that are frequently needed when applying for healthcare and other services. Please use the link provided to download or to apply on-line.

Medical Card Application Form

Applications for medical cards, allowing for both free GP visits for most services and free prescriptions for most items, is means tested. You can apply by downloading and filling in the form below.

Over 70s GP Visit Card Application

If you are over 70 you can register for a GP visit card, regardless of income. Everyone 70 years and over living in Ireland is entitled to a doctor visit card. The easiest way to apply is online using the link below.

Under 6s GP Visit Card Application

All children under 6 years of age living in Ireland can get a GP visit card. The under 6s doctor visit card covers GP visits and out-of-hours urgent GP care. Medication costs and hospital charges are not covered.

Long Term Illness Application Form

Under the Long-Term Illness (LTI) Scheme you can get some drugs, medicines and approved appliances for free from your pharmacy. There is no means test for the scheme. Illnesses covered by the scheme include Diabetes, Epilepsy, Multiple Sclerosis, Parkinsons Disease and Cystic Fibrosis.

Driving Licence Form (D501)

If you are over 70, or drive a Category 2 vehicle (bus, lorry), or suffer from an illness that can impair your ability to drive (eg diabetes, epilepsy), you must attend your GP for a driving medical before applying for your  licence. The form can be downloaded below. 

Maternity Benefit (MB3)

If you are self-employed or not currently employed, your doctor must complete this form after your 24th week of pregnancy. (If you are an employee, you will only need a certificate from your doctor for your employer who should fill out an MB2 form).