Dublin AMAU Contact Form

Please fill in all fields labelled * Required

Patient details

Patient First Name * (Required)

First Name is required

Patient Last Name * (Required)

Last Name is required

Email address

Please enter a valid email address.

Country code *

Country code is required

Phone number * (Required)

Phone number is required

Referral

Do you have a referral from your GP? * (Required)

Please indicate whether you have a GP referral

Enquiry

Please describe the nature of your enquiry: * (Required)

Suitable for admission

Follow-up after discharge

Billing enquiry

Insurance enquiry

General Information

Other

Please select the nature of your enquiry

Please note: This enquiry channel is not monitored 24/7 and operates during office hours Monday to Friday only. It should not be used for emergencies. If your enquiry is urgent during office hours, please call the AMAU on 01 806 5444 or attend your nearest Emergency Department.

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