Register

Your browser is unsupported. Please use Google Chrome, Microsoft Edge, Safari or a Modern Browser.

Your Role

Professional Professional and Parent Parent Other Relation
Aunt/Uncle Grandparent Sibling
Next

Your Account

Previous
Next

About You

Mr Mrs Miss Mx Dr Prof Other
Male Female Not Specified
Antrim Armagh Carlow Cavan Clare Cork Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Londonderry/Derry Longford Louth Mayo Meath Monaghan Offaly OTHER Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow

For text message purposes please drop the 0

Please enter a valid phone number
Would you like to receive updates from Middletown Centre for Autism?

You can login at any time to update your preferences.

Yes No
Phone Post Email
Previous
Next

About your profession

Behaviour Therapist Classroom Assistant Education Professional Education Psychologist HSE (Primary Care + Disability Staff Only) Occupational Therapist Physiotherapist Speech and Language Therapist Teacher Teaching Assistant Other
Nursery/Play/Pre School Mainstream Primary Special Education Setting/Autism Class Post Primary Further/Higher/Technical Educational Setting University Home Schooled None Other
ROI School Maintained (NI) Controlled (NI) Integrated (NI) Irish Medium (NI)
Previous
Next

About the Child/Children you are related to that have autism

Male Female Not Specified
{[tab.gender_error]}
Date of birth
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
{[tab.dob_day_error]}
January February March April May June July August September October November December
{[tab.dob_month_error]}
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
{[tab.dob_year_error]}
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
{[tab.diagnosed_year_error]}
 Nursery/Play/Pre School Mainstream Primary Special Education Setting/Autism Class Post Primary Further/Higher/Technical Educational Setting University Home Schooled None Other Autism ASD Asperger syndrome ASC PDA Awaiting Diagnosis Other
{[tab.diagnosis_error]}
Which are the main areas currently affected by autism? Anxiety Attention Behaviour Communication Daily Living Skills Family Life Interests and Hobbies Learning People and Places Physical Activity/Motor Skills School Attendance Sensory Processing Sleep Socialising and Play Transitions Between Activities
Diagnosed co-occurring conditions? Anxiety Disorder Attention-deficit Hyperactivity Disorder (ADHD) Cerebral Palsy Developmental Coordination Disorder (DCD) Down Syndrome Dyslexia Dyspraxia Obsessive-compulsive Disorder (OCD) Oppositional Defiance Disorder (ODD)
Remove Child
Add Child
Previous
Skip Next

Subscribe to our newsletter

Would you like to register for the Centre's newsletter? The Centre will not share the email you provide to third parties.

Subscribe
Previous
Next

Confirm Your Details

Please review your information before completing registration.

Account Details

Email: {[formData.email]}

Personal Information

Name: {[formData.title]} {[formData.first_name]} {[formData.last_name]}

Gender: {[formData.gender]}

Address: {[formData.address]}, {[formData.town]}, {[formData.postcode]}

Mobile: {[formData.mobile]}

By clicking "Complete Registration", you confirm that the information provided is accurate.

Previous
Complete Registration

Registration complete

Thank you for your registration.

Please check your inbox for a welcome email and click the link in order to verify your account.

If you cannot see your welcome email, please check your junk/spam folder.