Introduction to No Panic Sheffield

Introduction to No Panic

Knowing a little about you so you can attend our groups and we know how we can make things better. Contact details incase we need to contact people in an emergency, or if we have to cancel a session (this just makes it a lot harder to do without). Our sessions are drop-ins. You can come whenever you want. There are no waiting lists. Socials are once a month.
Name of person coming to groups

First NameLast Name
Name of Referrer (leave blank if the same)

First NameLast Name
How did you find out about us?

SPA/EWSRecoveryIAPTGPGoogleOther
Your contact e-mail
example@example.com
Your postcode

Street Address

CityCounty

E.g. S1 1AA
Contact Phone Number

Area CodePhone Number
Which sessions are you interested in coming to:

Wednesday 6:30-8:30pm blended (on-line option)Wednesdays 6:30-8:30pm blended (face-to-face)Thursdays 10am-midday (face-to-face)Socials (monthly)
Do you consider yourself to have:

AnxietyDepressionLow mood
How long have you had anxiety/depression/low mood/other?
Which of the following do you have? Please tick if any

General Anxiety DisorderOCD (including trich and BDD)Post-traumatic stress disorderEUPD/Borderline Personality Disorder/BPDSocial anxietyAgoraphobiaDepressionOther personality DisorderSpecific PhobiaPostnatal depressionBipolar disorderADHDAutism Spectrum DisorderOther
Could you describe your wellbeing/mental health needs in coming to a session. Also any details we need to be aware of e.g. person needs to attend with carer, any ongoing support or care. This includes in a group setting as we do not do 1-1.
How can we help you come to sessions and feel included? We want everyone to feel safe and comfortable so do tell us anything that will help them to feel at home and welcomed.
Please list any things you are happy to disclose that anxiety prevents you from doing
e.g. social situations, work, leaving the house
Have you ever had in the past, or presently:

An Eating disorderDependence or addiction to a prescription medicationDependence or addiction to alcohol or other drugsOn medication currentlyWas on medication in the past (not currently)
Have you ever had a 'talking therapy'? Tick if yes.

Cognitive Behavioural TherapyDialectical Behavioural Therapy (DBT)Trauma focussed therapyEMDRCounsellingOther
If you have have had a talking therapy, how helpful was it?
Would you like to be on our mailing list? This is mostly for session information and a means of informing you if sessions are cancelled. We do not offer a text reminder service that a lot of people ask for, but many people regard the emails as a reminder.

YesNo
By signing this form, you are giving consent to receive our service - No Panic Sheffield Self Help Group - and to be contacted via e-mail or telephone by No Panic Sheffield with information about our organisation and our meetings. We will not pass your details on to anyone else.
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