Join Us

Fill in the form below to register your interest in attending the first online course for McGuire Programme Ireland.

You will receive a response within a week.

* required – you must fill in these fields

First Name*required

Last Name*required

Home Address*required

City / County*required

Postcode/Eircode*required

Email address*required

Home Phone Number

Mobile Number*required

Date of Birth*required

Highest Level of Education:*required

Marital Status:*required

Occupation:*required

Name & Telephone Number of emergency contact (next of kin)*required

Any physical disabilities?*required

Yes

Are you currently on any medication?*required

Yes

Tell us about your sports and hobbies*required

What other speech or speech related psychotherapy have you had?

Type of therapy

Dates of therapy

Methods used

Results

What therapy worked the best for you and why?

Why do you think the other therapies didn't work for you? *required

Lack of motivation

Failure to work hard enough

No or inadequate follow-up support

Inadequate guidance

Lack of personal power from therapist

Other reasons

What do you hope to gain from our programme? *required

What do you want to do that requires good speaking ability? *required

In which of these upcoming courses would you like to apply to?*required

Type the characters*required

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