www.rushgp.ie

Applications to be a patient in the practice should be completed using this form. One form per person.

Once submitted, we will process your details and then contact you to book an obligatory introductory appointment with Dr. Foster or Dr. Kilmartin. During this appointment, the doctor will review your medical history and do a basic medical exam, including a Chest and Heart exam and baseline details, including BP, weight, height, etc.

This appointment is treated as a normal private consultation with the appropriate fee. For under 18-year-old registrations, they can accompany their parent during the same consultation without additional charge.

If the doctor is satisfied that our clinic will be able to meet your medical needs, they will accept you as a patient and ask you to sign consent to obtain medical records from your current GP. If the doctor feels the clinic is not a good match for your needs, they will inform you of the reason why.

New Patient Registration form

Surname

First name

Date of Birth

Sex at birth

Mobile phone number

Personal email address

Current postal address including Eircode

PPS number

Private Health insurer name/policy number

Detais of your medical history

Current medications with dosage

Next of Kin name

Next of Kin phone number

Name of Current GP

Ethnicity

Why do we ask for gender and ethniciy.? Gender is to help ensure the correct person is identified when we send blood samples or referals to the hospital and to help us identify those needing cervical smear tests , Prostate checks etc. Ethnicity is asked in order to help identify those where medical research have shown a higher risk for certain medical conditions.

Mothers Maiden Name (only required for those eligible for Cervick Check testing)

Lifestyle questionaire

Rush GP

Family Doctor in Rush Co Dublin

August 2025

We are now accepting new patients

New Patient Registration form