POMAS Registration

Register for POMAS

Complete the form below to register for your POMAS prescription service with Healthwave.

Step 1 of 4 — Member Details

First Name

Last Name

Date of Birth

Gender

POMAS Status

POMAS Policy Number

Step 2 of 4 — Contact & Address

Contact Details

Phone

Billing Address

Address Line 1

Address Line 2

Address Line 3

City / Town

County

Eircode

Delivery Address

Is your delivery address the same as billing?

Yes No

Delivery Address Line 1

Address Line 2

Address Line 3

City / Town

County

Eircode

Step 3 of 4 — Family Members

Family Members (Optional)

Add your partner and/or children if they will also be covered under this scheme.

Step 4 of 4 — Terms & Conditions

Privacy & Consent

I have read and agree to the Privacy Policy and consent to Healthwave processing my personal data for the purpose of providing pharmacy services under this corporate scheme.

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