Joining the Wellbeing Community

Joining the Wellbeing Community

This form is for those wanting to join the wellbeing community from Space to Breathe. All details are stored securely and data is held in accordance with GDPR legislation and Space to Breathe's Data policy.
About you
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 00000000000.
About your mental health and wellbeing
Tell us about your mental health and wellbeing
Give a brief description of the challenges you face with your mental health. If you have had a formal diagnosis please mention it here.
Select any of the following that apply

Other
If you are still receiving support of some kind, please give a few details.
This can include which teams you're working with, and any details of treatment you're receiving.
Please let us know anything that would help you access activities and support and anything that will help us look after you.
Allergies, access requirements, safety etc
Getting to know you appointment

To start with, we arrange a get-to-know-you appointment to kickstart your membership of the Wellbeing Community. The following details will help us arrange that appointment.
Would you rather your 'get-to-know-you' appointment was:

Other
Please select the best times of day for you to have an appointment
Please select the best days of the week for you to have an appointment
Thank you so much for completing this form. A member of the Space to Breathe team will be in touch shortly.
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Joining the Wellbeing Community

About you

About your mental health and wellbeing

Getting to know you appointment