Request for Medical Card Authorisation Form

As a medical card holder you may be entitled to a free eye exam and free glasses every two years. Please provide us with the details below?

 

We will contact you to assist in completing the "Form LOA/1". We will send your form to your local HSE clinic. When we receive the form stamped and authorised by the HSE, we will phone you to arrange an appointment.

Thanks for submitting!