GP Visit Card Card Number Yes No Medical Card and GP Visit Card Form MC1 1B 16 to 25 year old dependants con nued Yes Are you in school or college? No If Yes , what is the name of your school or college? When will you nish your course? Please ask your school or college to stamp this form. School or College Stamp: Part 2 Your dependants Your children or dependants (up to 16 years old) First name(s) Surname Date of birth PPS number Gender Rela onship (male or to y.
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How to fill out the Medical Card Application Form online
Applying for a Medical Card or GP Visit Card can be a straightforward process when completed online. This guide will walk you through each section of the Medical Card Application Form, providing clear instructions to ensure your application is filled out accurately.
Follow the steps to successfully complete your application.
- Click ‘Get Form’ button to obtain the Medical Card Application Form and open it in your preferred online editor.
- Fill in Part 1, which includes your personal details. Ensure your first name, surname, date of birth, PPS number, and contact details are accurate. Use people-first language when referring to dependants.
- If applicable, complete Part 2 regarding your dependants. Provide the required information including their names, dates of birth, and relationship to you.
- In Part 3, detail your family income. Accurately list weekly income sources and amounts, including social welfare payments, wages, and self-employment income. Pay attention to fields marked with a red star, as they require documentation.
- Complete Part 4 by providing information about your expenses. Include monthly costs for housing, childcare, travel to work, maintenance payments, and medical expenses. Ensure that documentation for these expenses is attached.
- Proceed to Part 5 where you will ask your family doctor to sign and stamp the form, confirming their agreement to provide medical services to you.
- Read and sign the declaration in Part 6, confirming that all information provided is accurate. Remember to include your PPS number and any other required information.
- After completing the form, review the checklist to ensure all relevant parts are filled out and all supporting documents are included.
- Finally, save your changes, download or print the completed form, and send it along with your documents to the designated address.
Start your online application for the Medical Card or GP Visit Card today!
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