Medinet Ireland
Talk to us
Medinet Ireland
Talk to us

Patient Consent Form

You can fill out the form below or click the link to download a PDF version

Download PDF Patient Consent Form

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This field is for validation purposes and should be left unchanged.

Patient Details

Name (as per passport):*
Address*
MM slash DD slash YYYY

Consent Statements

I agree to share my treatment plan with my GP*
I agree to share my medical records and data with hospitals within our network*
I agree to allow Medinet to contact me via phone, email, SMS, and WhatsApp.*

Signature

Type your full name above to acknowledge that the information provided is accurate.
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 Contact us to find out more

Phone<br />
Republic of Ireland
01 5134299
Northern Ireland
07539 133922
Email
Email us at:
contact@iemedinet.com

Who is eligible from ROI?

You can apply if you:

  • Are ordinarily resident in Ireland
  • Are entitled to public healthcare
  • Have a GP or consultant referral
  • Require a treatment that is publicly available in Ireland (e.g., hip or knee replacement)
  • Have a G-HIC/E-HIC and an in date valid passport.
Fill out our simple form

Let’s Get You Moving Again

Don’t wait in pain. Let Medinet Ireland help you access the care you deserve — faster, safer, and fully supported.

Republic of Ireland:  015134299
Northern Ireland:  07539133922
Email us at:  contact@iemedinet.com

Who is eligible from Northern Ireland?

You can apply if you:

  • Are an ordinary resident of NI and entitled to the full range of HSC services.
  • Have been diagnosed by an HSC Trust consultant.
  • Have been on the HSCNI surgery waiting list for ≥1years.
  • Your surgery is one commissioned by DoH for their diagnosis and would have received within HSC under the same clinical circumstances.
  • Will pay for the surgery themselves THEN reclaim costs from DoH.
  • Have NOT sought any other source of reimbursement.
Fill out our simple form