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
*
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
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