Wellsprings - Music Group Application
Herefordshire Mind in partnership with Encore run a weekly music and songwriting group at Herefordshire Mind. This runs weekly on a Friday between 12:30pm and 2:30pm at Hub for Hope. Please fill out the below application form to show interest for the group and a member of the team will get back to you with the availability for when you can attend.
Name
First Name
Last Name
What are your preferred pronouns?
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What other services are you currently receiving support from for your mental health?
Neighbourhood Mental Health Team
Other Herefordshire Mind Services
GP
NHS Talking Therapies
Private care
Housing
Other
Why are you interested in attending the music/songwriting group?
Do you have any reasonable adjustments or accessibility requirements to make us aware of?
Where did you hear about the music/songwriting group?
Social Media
Mental Health Team
Another Herefordshire Mind service
Through a friend or family member
GP
Other
Next of kin details:
Please include name and emergancy contact details
Thank you for expressing your interest!
A member of the team will get back to you shortly with more information.
Submit
Should be Empty: