Registering with the IMNDA - IMNDA %

Registering with the IMNDA

Please note this form is for somebody with MND only. If you are registering on a person’s behalf (with their consent) please call the office on 01 873 0422. Thank you.

  • Your Details

  • Date Format: MM slash DD slash YYYY
  • How do you wish to receive contact from the IMNDA?

  • Next of Kin/Contact Person Details

  • Does next of kin wish to receive contact from the IMNDA?


  • Date Format: MM slash DD slash YYYY
  • Your Healthcare Team (if known)






  • This field is for validation purposes and should be left unchanged.