Oakfield Nursing and Retirement Home Gorey Wexford, Convalescent and Nursing Care

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Booking Enquiry

Oakfield Nursing Home Booking Form

Proposed Resident:

Surname:

First Names:

Date of Birth:

Address:

Phone No:

PPS No:

Medical Card No:

Next of Kin:

Name:

Address:

Phone:

Person Responsible for Payment of Bills:

Name:

Address

Phone No:

General Practitioner:

Name:

Address:

Phone No:

Type of Room Required

Please Choose

Single
Shared

Room Required From: (Approximate date)

If admission is from hospital please supply:

Name of Hospital:

Ward / Room No:

Contact Person:

Phone No:

Admission is subject to availability and assessment of the proposed resident

Please enter the digits as seen