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Apply

Download the application form in English or Irish or LoCall 1890 252 919 to order one.

Send the completed application form to:

LTI Client Registration Unit
PO Box 12962
Dublin 11
D11 XFF3

What to include in your application

Your doctor or consultant will need to sign the form and provide a medical report.

On the form, they will list any:

  • long-term illness conditions you have
  • medication and appliances you need to treat your condition

You will need to provide the following personal information:

  • Full name
  • Address
  • PPS number

Incomplete applications take longer to process. This is because we may need to contact you for more information.

Related Content

page last reviewed: 28/05/2019
next review due: 28/05/2022