Order a CHD support card

Who is ordering the card?

I’m a parent or guardianOrdering for my child or someone I care for. Emails come to me. I’m ordering for myselfYou need to be 16 or over.

About the cardholder About you

First name

Surname

Date of birth

Which card?

Under 16s get a child card and 18s and over an adult card. At 16 or 17 you can choose.

Child card Adult card

Medical information for the card

Only confirmed diagnoses. This is printed on the card so emergency staff can see it.

Or, if none of these fit

The condition isn’t listed Not sure Prefer not to say

Condition name, if not listed

Do they have an implanted defibrillator (ICD)? Do you have an implanted defibrillator (ICD)?

Yes No Not sure Prefer not to say

Do they take blood-thinning medicine? Do you take blood-thinning medicine?

Yes No Not sure Prefer not to say

Your contact details

We email your private status link here, and the address is where we post the card.

If you’re a parent or guardian

Your full name

Your email

Your phone (optional)

If you’re ordering for yourself

Email

Phone (optional)

Where should we post the card?

Address

Address line 2 (optional)

Town or city

County

Eircode

Name on the envelope (optional)

Leave blank to use the name of the person ordering.

Add a passport-style photo

Face the camera with a plain background, and no hat or sunglasses.

Take a photo Choose from your photos

Photo (JPEG or PNG)

We’ll crop it to passport shape. Face the camera with a plain background, and no hat or sunglasses.

Check and send

This is how the card will look. Heart Children check it before it’s printed.

Check your answers above before you send.

I confirm that I am the parent or guardian of the child cardholder and am authorised to apply on their behalf. I have read the Privacy Notice and explicitly consent to Heart Children collecting and using the child's medical information, including their CHD, implanted-defibrillator status and blood-thinner medicine status, to review the application and print it on their support card. I confirm that I am the adult cardholder and have read the Privacy Notice. I explicitly consent to Heart Children collecting and using the medical information I provide, including my CHD, implanted-defibrillator status and blood-thinner medicine status, to review my application and print it on my support card. Read the privacy notice

I understand that this card contains limited information provided in the application and is not proof of identity, a complete medical record or an emergency treatment plan. (optional)