Eligibility Check List.
If you are filling in this form on behalf of someone else, please add their name and age at the bottom of this page.
What arear does the person live in?
Have they experienced any of the following?
Are they currently accessing therapy through another service?
Have they been diagnosed with a mental illness? If answered yes, please give details below.

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If you do not hear back from us please do not hesitate to contact us to access our services privately, or to find out more about what else we can offer.