Self Registration form

This function allows people who have diabetes to register themselves with Diabetic RetinaScreen - The National Diabetic Retinal Screening Programme. Health professionals can register their clients directly using the registration option under the 'Health professionals' tab above.

Please enter your details below and proceed to the next page to print the registration form for completion by your family doctor (GP).

Thank you.

Registration form

First Name

Middle Name

Surname

PPSN

We need your PPSN number to ensure you are correctly identified on our Register.

Date Of Birth

Sex

Surname at Birth

Mother's Maiden Surname

Find my address

Edit address

Address Line 1

Address Line 2

Address Line 3

Town

County

Eircode

Phone Number

Privacy Notice

When you take part in Diabetic RetinaScreen you will give us some personal data. This includes data such as your name, address, date of birth, mother’s maiden name, PPSN and other relevant healthcare information. The HSE’s National Screening Service is the data controller for your personal data. We will keep your personal data safe and private. We will follow data protection laws for storing and using your personal information. We use this data to complete your screening test, invite you for follow-up tests if necessary, and invite you for future screening. We may also use it for:

quality assurance or quality improvement
external accreditation
risk or claims management
sending appointment reminders
sharing your patient experience with us
contacting people to help us with research
Other purposes carried out in fulfilment of our responsibilities as a public health service.

We will not use your data for health research without consent. We will also follow the HSE’s data protection policy. You can find out more about your data protection rights and how to use them at www.hse.ie/gdpr

To enable the Next button, please read over and confirm the information you provided above is accurate.

I confirm all the information above is correct and accurate.

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Diabetic RetinaScreen

Email: info@diabeticretinascreen.ie
Freephone Information Line: 1800 45 45 55 Choose option 1.

Is cuid den tSeirbhís Náisiúnta Scagthástála é Diabetic RetinaScreen	Diabetic Retina Screen is part of the National Screening Service

Saorghlao 1800 45 45 55	Freephone 1800 45 45 55

Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh. The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive in Ireland. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.

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