Contact Us Aug 17, 2023Jan 21, 2026 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Parent(s) Name(s) *Child's Name *FirstLastChild's Age (*Note: We Only Consult With Parents Of Children From 3 - 12 Years Of Age) *Date Of Birth *Address *E-mail *Mobile Number: *Does Your Child Have A Diagnosis Of Anything Or Do You Have Any Concerns Of An Underlying Diagnosis? *Siblings Names & Ages (& Do Any Of Them Have A Diagnosis Of Anything?) *Is Your Child On Any Medication For Anything That Could Be Impacting On Their Behaviour? *Are They At Preschool/Primary School/Special School & What Class Are They In & Do They Have An SNA? *Do They Have A Childminder? *Do They Go To Breakfast Club? *Do They Go To An After School? *Please List Below The Type Of Behaviours You Would Like To Address, For Example: Not Accepting No, Refusing To Do As Asked, Difficulty With Their Big Emotions, Etc. *Has Your Child Ever Witnessed Or Experienced Any Trauma Or Abuse - Please Note These Are Cases We Do Not Take On. *Is There Any Alcohol Or Substance Abuse In The Family Home - Please Note These Are Cases We Do Not Take On *Where Did You Hear About The Service: Word Of Mouth, Newsletter, Online? (If Online, Please State Where, Facebook, Instagram, Google, Letterkenny Babies, Etc.) *Submit Form
