New Patient Registration

Three short steps—most patients finish in under two minutes.

Step 1 of 3

Your First Name(s)*

Your Last Name*

Your Date of Birth*

Format: DD/MM/YYYY (e.g., 31/08/1980). Slashes are added automatically.

Gender / Preferred Pronoun*

Full Address (including Eircode)*

Your Phone Number*

Enter exactly 10 digits (numbers only). Example: 0812345678

Your Email*

By continuing you agree to our Privacy Notice. Your details are stored securely and reviewed only by our medical team.

Need help? Call 01 293 7177 or email info@dublinpainclinic.ie. We respond within one business day.