The Medical Centre Registration Step 1 of 3 - Personal Details 33% Personal DetailsStudent Number*Name* First Last Home Address* Street Address Address Line 2 City ZIP / Postal Code Waterford Address Street Address Address Line 2 City ZIP / Postal Code Home Phone Number*Mobile NumberDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please indicate your year of study* 1st 2nd 3rd 4+ Medical DetailsDo you have any of the following Medical Conditions? Asthma Epilepsy Diabetes Physical Disabilities Other Past illness or operationRelevant Family HistoryCurrent MedicationAllergiesPPS Number Payment DetailsPlease indicate if you wish to avail of a Scheme* Yes No Method of Payment*Cash / CardMedical Card (no payment required)Annual Fee €99.00Total 0,00 €