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Referral

Intake Form

Child Referral Enquiry

Welcome to a world of limitless possibilities, where the journey is as exhilarating and where every moment is an opportunity.

Thank you for your response. ✨

Parent / Guardian’s Full Name*

Child’s Full Name*

Child’s Date of Birth (YYYY-MM-DD)*

Parent / Guardian Phone number*

Address*

Email*

GP Name & Contact Details*

Please let us know which service you are seeking*

Child Therapy Child Assessment

Has your child had any involvement with the following

Speech and Language Therapy Occupational Therapy Psychology Play Therapy Psychiatry Paediatrician Other

Name / Contact Details of services above

Are you referring for any assessments

Autism Assessment ADHD Assessment Cognitive Assessment/ Learning Assessment Not Sure

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Mynd Clinical Psychology is a neurodivergent-affirming private practice of chartered clinical psychologists based in North Dublin, Ireland.

Services can be offered face-to-face or online.

Bayside Clinic

Unit 11 Bayside Medical Centre, Bayside Square, Dublin D13 W2

Malahide Clinic

6 St James’ Terrace, Malahide, Co. Dublin, K36 Y972 – Level 2, Bell number 11

Get in Touch

welcome@myndpsychology.ie

Make an Enquiry →

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