Here you can find links to fill out our online forms, or you can download them and fill them out offline.

The Faythe Medical Centre Patient Forms

Repeat Prescription Form

Repeat Prescription Form Online

Patient Registration Form

Patient Registration Online Form
Download Patient Registration Form

Sexual Health Questionnaire

Sexual Health Online Questionnaire
Download Sexual Health Questionnaire

Prescription Order Form

Prescription Order Online Form
Download Prescription Order Form

Travel Vaccine Checklist

Download Travel Vaccine Checklist

Other Useful Forms

Medical Card / GP visit Card Application (Form MC1)

Download Medical Card / GP visit Card Application (Form MC1)

Medical Card Application for over 70s (Form MC1a)

Download Medical Card Application for over 70s (Form MC1a)

Health Expenses – Claim for Relief (Form MED1)

Download Health Expenses – Claim for Relief (Form MED1)

Dental Expenses – Claim for Relief (Form MED2)

Download Dental Expenses – Claim for Relief (Form MED2)

Maternity Benefit Application (Form MB10)

Download Maternity Benefit Application (Form MB10)

Medical Report for Driver’s Licence (Form D501)

Download Medical Card Application for over 70s (Form MC1a)

European Health Insurance Card Application Form

Download European Health Insurance Card Application Form

Drugs Payment Scheme Application

Download Drugs Payment Scheme Application