Limerick - Autism Assessment Booking & Enquiries Form TCC

1
This booking form is ONLY to book Autism Assessments (we like to call it Identification work) in our new clinic space in Limerick.

Autism assessments are the only service currently being provided in our Limerick clinic space.

For all other bookings with The Children's Clinic, please use our other booking link on our website.

Please be aware that filling in this form is not a guarantee that we will be able to see your child. We only have a limited number of spots available in Limerick currently and once they are filled we may not have more.
2
Please note that if your child is experiencing significant mood/mental health concerns, including depression, post-traumatic stress, self-harm or suicidal thoughts, they need to access support for these before attending with us for assessment.

Please speak instead to your GP for an urgent referral to CAMHS and to discuss other options. If you are immediately concerned for your child’s safety present to A&E.

We do not also provide reports for family court proceedings or other legal matters,

Please note that it is The Children’s Clinic policy that all legal guardians sign our consent form and are in agreement that your child receive services from us. Children will not be seen in the clinic until the signed consent form is received by us.

Click here to start ->
3
Please fill out below.* This field is required.
Full Name
Child's Full Name
Email Address
Mobile Number
4
Child's Date of birth* This field is required.Child's Date of birth
5
Address
Address Line 1
Address Line 2
County
6
My child is in* This field is required.
Creche
Preschool
Mainstream Primary School
Mainstream Secondary School
Autism Class Primary
Autism Class Secondary
Special School
Home Schooled
Other
7
Please provide some brief information about why you wish to explore if your child is Autistic.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
8
How did you hear about us?* This field is required.
Search Engine (eg Google)
Friend/Family
Facebook
Online Discussion Forum
GP
Other Professional
Word of Mouth
Other
9
Is your child already on The Children's Clinic waitlist for an autism assessment?
YESNO
Should be Empty: