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Apply for a Long-Term Illness Scheme card

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:

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

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

Page last reviewed: 6 October 2022