Send message to Clinic Manager

Have you attended this clinic for a consultation with a Doctor before now*
- YES
- NO
When did you last attend (month and year)
CONFIDENTIAL message for the Clinic Manager*
Provide enough information to allow the Clinic Manager to fully consider your question so that the Clinic Manager will be able to respond to you by SMS.
Patient Name*
Patient Mobile Telephone Number*
If your mobile is NOT Irish then include your country code, city area code and mobile number
REPEAT Patient Mobile Telephone Number*
Type carefully and make sure your number is accurate
Patient Email*
We usually communicate with you by SMS Text Message but if we send you an email it is sent from NoReply@NoReply.ie If you cannot find it in your Inbox please check your SPAM or JUNK folder
Repeat Patient Email*
Type carefully and make sure it is accurate
Patient Date of Birth (in format Day then Month and then YEAR)*