Welcome to Centric Health Specialist Care.

Please download or complete the following form and hand it back to reception where it will be included in your medical record. You will receive a copy for your records.

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Next of Kin

We adhere to Medical Council guidelines and principles of the Data Protection Legislation in relation to all our patient data. Further details are available in our Practice Privacy Statement.

Centric Health Specialist Care is a multidisciplinary site. In order to ensure you receive the best medical care possible we will process your medical information under a legal basis Vital Interest for the purpose of Data Protection.

Your medical file may need to be shared with other specialists and health professionals in the case where a second opinion is required or where a specialist opinion in a particular field is required. Principles of confidentiality and data minimisation will be followed.

We would like to draw your attention to our Privacy statement which is shown in Practice and available at www.CentricHealth.ie/privacy. You may also ask a member of staff for a copy.

After your consultation we will issue a feedback questionnaire which will be issued by post / e-mail. Please specify which method is preferable.

I hereby understand the information contained in this form and understand that I will receive a copy of same. I also understand that my medical information will need to be processed and shared amongst specific clinicians.