Apply for a Long-Term Illness Scheme card

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