Please print and fill out the following form. Once completed you can email to firstname.lastname@example.org, post to 12 Mary Street Medical Centre, Clonmel, Co. Tipperary or hand into reception. Please ensure that all sections are completed. Should you have any queries in relation to this, please contact the surgery on (052) 6121288.
Please allow 5 – 10 working days for your application to be processed, thank you.