Request a Meeting

How to Request a Meeting?

If you are eligible to request a meeting this must be done in writing. The Facilitator receives all requests and appoints a Moderator to each one. 

The application form is available to download here.

You can complete the application form in a number of ways:

  • You can fill in the Request a Form box. We will post you a form with a stamped self-addressed envelope and you can complete and return it us. 
  • You can print it out from the link above, complete it and send it to us.
  • You can complete it electronically and either email it to us or send it through the Submit Your Form box below. Please note, depending on your browser, you may need to save the form before you are able to edit. 

If you choose to post the form to us please send it to: 

The Facilitator
Restoration of Trust Meetings
Lis Cara Business Centre
51 Fitzwilliam Square W
Dublin 2, D02 X504

If you choose to email it please send it to
If you need any help or have questions about completing the form please email us at or call us at (01) 665 0464 and we will assist you.  

Please note all applications will be dealt with in the strictest of confidence.

Request a form
If you would like us to send you out a form with a stamped self-addressed envelope, please complete the details below and we will post this to you.

    Submit your form
    To submit your form through the website please download and save it to your device. When you open the form on your device you should be able to edit and save it. You can then submit it below by attaching it as a file.

      Information for those not eligible
      As eligibility has been set out in legislation, you can only apply to us if you fall under one of the eligibility categories. 

      If you are not eligible to apply to us, you may be able to speak with the National Screening Service who has put in place a personal cervical screening review.

      To request a review, you must have:

      • had a cervical cancer diagnosis
      • had a CervicalCheck screening test in the 10 years before your diagnosis

      The Screening Services advise that a review may help you or your family if you:

      • are looking for answers or ways to understand how and when your cancer developed
      • want to ask questions about your screening journey

      More information on the reviews can be found here

      Please note the Restoration of Trust Meetings is an independent body and has no involvement with this process. Any queries directly related to this process should be directed to the National Screening Service.