Name: Weekend Doctor STI Clinic
Brand: GP Services
SKU: NAS-WEE-01-01
Price: 60 EUR
Availability: InStock
Rating: 5 (898 reviews)

CONSENT – do you give permission to us to communicate with you by SMS Text Message and / or Email*
- Yes
- No
YES response is obligatory if you wish to have a medical appointment with this clinic
Did you ever attend this before*
- Yes
- No
DOCTOR's Name (If known) & Address (your regular or most recent Doctor)
Dr REGAN or the Nassau Clinic is NOT your Doctor – this is an emergency out of hours service only
Pharmacy Name (if known) & Address where we should send any prescription
Have you already been given your appointment time?(Required)*
- Yes
- No
Before completing this patient questionnaire, you must first have been given an appointment time by either (a) booking online via www.Nassau.ie/book or (b) by telephoning or the clinic on 015242848 or visiting the clinic and speaking with the manager about appointment times
What Day is Your Appointment*
- Saturday
- Sunday
- Thursday
Appointment Time*
- Morning
- Afternoon
- Evening

RECENT MEDICAL – have you been with a Doctor or in a Hospital in the last 4 weeks*
- Yes
- No
Reason for your recent medical visit and the name of the Doctor or Hospital
ALLERGIES – are you allergic to any medication*
- Yes
- No
ALLERGIES – Please list any medication that you are allergic to
REGULAR MEDICATION – do you take regular medication*
- Yes
- No
REGULAR MEDICATION – Please list ALL medication that you take
Are you IMMUNOCOMPROMISED*
- Yes
- No
Why are you immunocompromised

EIRCODE (Irish Postal Code) if known
Address (in Ireland) Line 1*
Address (in Ireland) Line 2
Address (in Ireland) Line 3
Address (in Ireland) Line 4

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https://www.nassau.ie/pq/

https://www.nassau.ie/pq/

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In a life-Threatening Emergency Dial 999 or 112