Referral Process

• Download and complete the Referral Form:
  • Referral Form – Word Document
  • Referral Form – PDF
  • Referral Form – Eating Disorder Recovery Centre
  • Covid Screening Quentionnaire – Word Document
  • Covid Screening Questionnaire – PDF
• Fax completed form to the Admissions Office at 01-277 1455
• The patient will be contacted directly by the Admissions Officer and advised of the date and time of their admission
• Admissions Officer will notify GP or other referrer of the arrangements separately

• Post referral letter to Dublin County Stress Clinic, Saint John of God Hospital, Stillorgan, Co Dublin or fax to 01-288 5107
• The patient will be contacted directly and advised of the date and time of their appointment
• GP or other referrer will be notified of the arrangement separately

• Referral Form – Word Document
• Referral Form – PDF
• Covid Screening Quentionnaire – Word Document
• Covid Screening Questionnaire – PDF

Note: If the person being referred is under the care, or recently under the care, of another Consultant Psychiatrist or Psychiatric Service, then the referral should be made by that Consultant or Service.

1. Download and complete our Referral Form
   • Referral Form – Word Document
   • Referral Form – PDF
2. Fax completed form to the Admissions Office at 01-277 1455.
3. The GP can contact the hospital via the Admissions Office on 01-277 1450 from 8.30am to 8.00pm Monday to Friday and 01-277 1400 outside these times and weekends.
4. It is important that Application Form 1, 2, 3 or 4 (Applicant) and Recommendation Form 5 (GP) are completed accurately and within 24 hours. The completed forms should be faxed to the Admissions Office at 01-277 1455 prior to the patient’s arrival.
5. These forms must be inspected by the Hospital’s authorised staff before admission. Inaccurate completion of forms can lead to a delay in admission.
6. The help of an Assisted Admission Team* may be arranged by contacting the Admissions Office on 01-277 1450.
7. The GP must ensure that the original Mental Health Act paperwork (Forms 1-5) accompanies the patient to the Hospital with a family member or with the assisted admission team as these are statutory documents required for the legal detention of an involuntary patient.

Mental Health Commission Forms 1–5 can be downloaded as follows:

Form 1:  Application (to a registered Medical Practitioner) by Spouse or Civil Partner or Relative
Form 2:  Application (to a Registered Medical Practioner) by an Authorised Officer 
Form 3:  Application (to a Registered Medical Practitioner) by a member of An Garda Síochána 
Form 4:  Application (to a Registered Medical Practitioner) by any other person
Form 5:  Recommendation (by a Registered Medical Practitioner)

* Assisted Admission Team:
This is a specialised statutory service designated by the Irish Mental Health Act 2001/09. The service provides a safe and discreet client and family-centred service throughout the country, which assists the person with mental health and/or learning disability issues and who is unwilling to go to hospital voluntarily for assessment.

Useful Links:

• Mental Health Act FAQ

Note: If the person being referred is currently under the care, or has been recently under the care, of another Consultant Psychiatrist or Psychiatric Service, then the referral should be made by that Consultant or Service.

• Download and complete the Referral Form:
  • Referral Form – Word Document
  • Referral Form – PDF
  • Referral Form – Eating Disorder Recovery Centre
  • Covid Screening Quentionnaire – Word Document
  • Covid Screening Questionnaire – PDF
• Fax completed form to the Admissions Office at 01-277 1455
• The patient will be contacted directly by the Admissions Officer and advised of the date and time of their admission
• Admissions Officer will notify GP or other referrer of the arrangements separately