Request FULL RECEIPT of PAYMENT for Medical Consultation (include MY NAME)

Note - if you have previously requested this receipt by email, please first check your SPAM or JUNK folder for an email from our email address which is NoReply@NoReply.ie

Name of Patient that must be printed on the RECEIPT*

First Last

Amount that you paid*

If you cannot remember the precise amount, what was the approximate amount?

How did you pay?*

Debit or Credit CARD
Cash

Date of Medical Consultation*

Your Email*

Your Mobile / Cell Phone Number*

REPEAT your Mobile / Cell Phone Number*

Your Email*

Repeat your Email*

EIRCODE - 7 characters long*

https://finder.eircode.ie/#/

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Request a Receipt

Request a Receipt

Receipt Request

Request FULL RECEIPT of PAYMENT for Medical Consultation (include MY NAME)

In a life-Threatening Emergency Dial 999 or 112