Individual Application

Become a member of Panacea Care and ensure that you receive the best out of hours medical care Ireland can offer and direct access to top emergency medicine consultants.

Use the link below to complete the application form.

Individual Application Form

Title

Name

First Name

Last Name

Date of birth

YYYY

Gender

Occupation

Nationality

Home address

Telephone (Mobile)

Telephone (home/other)

Private Health Insurance

Are your currently insured with a private health insurer

Yes

If yes please specify your private health insurer

Please note that by providing your email address, you understand that you will receive your Policy and renewal documentation electronically. If you wish to receive by post, tick here.

Prefer Post

Consent to sending your personal data

We will use your personal data in order to process your applica1on for Panacea Care and to administer your policy, in accordance with the details outlined in our Privacy Policy

Consent

4 Stages Of Panacea Care

1. Video Call

Secure video call with a Consultant in Emergency Medicine

2. On-Site Treatment

After hours visit to your home or workplace if required

3. Onward Referral

Further tests or follow-up at our private hospital if required

4. Hospital Admission

Admission to a private hospital overnight or next day if required