HCP Referral Portal

Secure submission for driver assessments and consultations. Partnering with you for patient safety.

Submission Guide

Please ensure all mandatory fields (marked with an asterisk) are completed to avoid delays in patient assessment scheduling.

Secure Handling

Data is encrypted and stored securely in compliance with GDPR.

24-Hour Review

Referrals are typically processed by our specialist team within one business day.

Healthmail White Site

DAI is a Healthmail white site — you can also email info@dai.ie securely from any Healthmail address.

Full Name *

Practice / Hospital Name *

Contact Healthmail/HSE Email *

Contact Phone *

Patient Full Name *

Date of Birth *

Patient Address

Patient Eircode

Patient Contact Number

Reason for Referral *

Alternative Contact Name

Alternative Contact Ph or Email

Clinical Notes & Relevant History *

Upload Supporting Documents (optional)

PDF, DOC, DOCX, JPG or PNG. Max 5 MB.

I confirm that I have obtained necessary patient consent for this referral and data processing

Healthmail White Site

DAI is also a Healthmail white site, meaning you can email info@dai.ie securely from any Healthmail email address.

GDPR & Data Protection Act 2018

Your data security is our highest priority. All data is encrypted and stored securely in compliance with GDPR.