info@cssdoctor.ie
09066 26644
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  • Our Practice
    • Welcome
    • Practice Team
      • Dr. Martina Hanratty
      • Dr. Cyril Crosbie
      • Dr Brendan Crosbie
      • Dr Claire Keaveney
      • Dr. Caoimhe Crosbie
      • Registrar
      • Practice Nurses
      • Practice Manager
      • Support Team
    • Practice Policies
      • Payment
      • Out of Hours
    • Medical Forms
    • Test Results
    • General Privacy Statement
  • Services
  • Prescriptions
  • Appointments
  • Fees
  • Payment
  • Contact
  • Home
  • Our Practice
    • Welcome
    • Practice Team
      • Dr. Martina Hanratty
      • Dr. Cyril Crosbie
      • Dr Brendan Crosbie
      • Dr Claire Keaveney
      • Dr. Caoimhe Crosbie
      • Registrar
      • Practice Nurses
      • Practice Manager
      • Support Team
    • Practice Policies
      • Payment
      • Out of Hours
    • Medical Forms
    • Test Results
    • General Privacy Statement
  • Services
  • Prescriptions
  • Appointments
  • Fees
  • Payment
  • Contact

Medical Forms

  • Home
  •  
  • Medical Forms

General Forms

 

    • Medical Card / GP Visit Card Application Form (MC1)
    • Medical Card Application Form for over 70s (MC1A)
    • Medical Card Change of Doctor Form
    • Medical Expenses Claim Form (Med1)
    • Vaccine Record Request Form
    • Subject Access Request Form
    • Transfer of Notes Request
    • New Patient Application Form

Prescription Forms

  • Prescription Order Form

Personal Injuries Board Forms

  • PIAB Medical Assessment Form

Social Welfare Services Forms

  • Disability Allowance Application Form (DA1)
  • Domiciliary Care Allowance Application Form (Dom Care 1)
  • Invalidity Pension Application Form (INV1)
  • Maternity Benefit Application Form (MB10)

Driving Related Forms

  • Medical Report for Driver’s License (D501)
  • Driving Licence Eyesight Report Form (D502)

Other Forms

    • New Childhood Vaccination Schedule Form
    • Cervical Check – Cervical Cytology Form
    • European Health Insurance Card Application Form
    • Pre-Travel Health Record
    • Long Term Illness Scheme Application Form
    • Drugs Payment Scheme Application Form

Opening Hours

8am – 5pm
(Mon – Fri)
(Closed from 1pm – 2pm)

OUT-OF-HOURS
WESTDOC provide out-of-hours emergency doctor cover after 6pm Mon – Fri, weekends and bank holidays. Call 0818 360 000

Contact

Castle Street
Roscommon Town
Co. Roscommon
F42 P797

Tel: 09066 - 26644
Fax : 09066 - 27572
Email: info@cssdoctor.ie

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Registering as a patient:

At this time, we are not accepting any new patients, unfortunately.