Apply for a Long-Term Illness Scheme card

You can apply for the Long-Term Illness Scheme by post.

Download an application form:

• Long-Term Illness Scheme application form (PDF, 404KB, 6 pages)
• Scéim na dTinneas Fadtéarmach foirm iarratais (Irish, PDF, 1163KB, 6 pages)

Complete the form and post it to:

Long-Term Illness Scheme,
Client Registration Unit,
PO Box 12962,
Dublin 11,
D11 XKF3

If you cannot download the form:

• phone 0818 224 478 to order one over the phone
• get a form for your local local health office

What to include in your application

You'll need to provide your:

• full name
• date of birth
• sex
• PPS number
• address
• contact details
• proof of address

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