This form is for NON-URGENT appointments for at least 72 hours in advance. For more urgent requests please call our surgery.
You must be a current patient of The Surgery Athenry to use this form.
Contact Number (required)
Date of Birth (required)
Appointment Type (please select)
Annual ReviewAntenatalBloodsCervical SmearChildhood ImmunisationDriving LicenseMirena Coil/ImplanonStandard consultWellman/Wellwoman
Preferred Time (am or pm)
Have you tested positive for Covid 19?
Have you been in hospital recently or been in close contact with someone who tested positive with Covid 19?
Have you any covid 19 related symptoms today?
We will confirm your appointment by text message only.
Please tick here to give permission.