Patient of the Bon Secours Health System Dublin

If Corporate Patient, please give Contact Name, Address and Phone Number of Company

Previous Attendance at Bon Secours Health Screening Department? No Yes

Please state which Health Screening Package you require: Comprehensive Health Screening for Men/Women - 420 Euro Corporate Health Screening Package - 395 Euro

Reason you wish to see a dietitian: Counterweight Counterweight Plus Counterweight Families

Other reason, please specify:

Optional Extra Tests required: Cardiac Stress Test - 150 Euros Dexa Scan - 85 Euros Cardiac Stress Test - 150 Euros Dexa Scan - 85 Euros Nutrition Screen & Consultation - 60 Euros Full Pulmonary Function Test - 60 Euros Physiotherapy Consultation (If Req.) - 50 Euors

Extra Tests Required for Women only: Mammogram - 125 Euros Smear Test - 25 Euros