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"*" indicates required fields

Before you commence this process of providing photo ID, you must have your ID photo already stored on this device. A smaller ID Photo file size is more likely to upload successfully.You will be asked to select the ID photo file and upload it.WARNING - you cannot take a photo from within this form, you can only load a photo that you previously took and which is already stored on this device.

FIRST NAME (forename) of patient (as shown on PASSPORT)*

SURNAME (family last name) of patient (as shown on PASSPORT)*

PATIENT DATE OF BIRTH*

Day

Month

Year

Age

SEX (as shown on your PASSPORT)*

Male

Female

Upload PASSPORT (or DRIVING LICENCE) photo image*

Drop files here or

Max. file size: 70 MB, Max. files: 3.

Once you upload your ID Photo by clicking the box above " SELECT FILES" and choosing a file, you will see displayed above - the name of the file that you have selected, the file size (small is best!) and a % figure. When the % reaches 100% you can answer YES to the next question below .

Is your PASSPORT (or DRIVING LICENCE) uploaded above

Yes

No

When you press CLICK HERE below, please be patient as it can take 1 minute to click to send your passport (or driving licence) photo to us. Please wait patiently until you get a message stating "THANK YOU for submitting your PASSPORT (or Driving Licence) photo to the Nassau Clinic"

In a life-Threatening Emergency Dial 999 or 112

Nassau Clinic, Weekend Doctor, Suite 17, First Floor, Morrison Chambers, 32 Nassau Street, Dublin 2, D02 XW77.
Telephone Call: (01) 524 2848

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