Circuit Court Forms

FORM 45

AN CHÚIRT CHUARDA

THE CIRCUIT COURT

CIRCUIT                                                                                                            COUNTY OF

IN THE MATTER OF THE MENTAL HEALTH ACT 2001

NOTICE OF APPEAL PURSUANT TO SECTION 19 OF THE MENTAL HEALTH ACT 2001

BETWEEN

Appellant

and

Mental Health Tribunal

Respondent

TAKE NOTICE that an appeal will be made to the Court sitting at ………… on the …..day of ……. or the next opportunity thereafter against the decision of a Mental Health Tribunal notice of which was received by the appellant or his/her legal representative on the ….. day of ….. (and a copy of which notice is annexed hereto) affirming an admission order/ a renewal order made under section 17 of the Mental Health Act 2001 in respect of the appellant on the grounds that the appellant is not suffering from a mental disorder

And the appellant will apply for an order revoking the said admission order/ renewal order

[and insert details of any consequential or supplementary relief sought in the appeal]

Dated the …… day of ………...

Signed ................................

Appellant /Solicitor for the Appellant

To: Mental Health Tribunal, Respondent

care of Mental Health Commission

St Martin’s House, Waterloo Road, Dublin 4

And

To: The County Registrar

And to: ……………….., Consultant Psychiatrist (Notice Party)

And to: Clinical director of approved centre at ……………….. (Notice Party)