Register For A Drop In

Registration Form

1. First Name

Last Name

2. Date Of Birth

3. Address Line 1

4. Address Line 2

5. City

6. County

7. Postal Code

8. Contact Number

9. Contact Email

1. What type of session is this booking for?

2. Select the Coffee Morning Session (Friday 29th May)

- Select Option - Supporting Transitions (Wed 1st July) Managing Low mood (Wed 11th Nov) Children and Anxiety (Wed 23rd Sept)

3. Is there anything you would like us to know before the session?

1. I understand this is a support session and not a full assessment or ongoing therapy, and that the information provided is used to enable access to the session.

Yes

2. I consent to Medway Therapeutic Alliance storing and using this information to create or update a client record, to support current and future care.

Yes

If we are worried about someone’s safety, we may need to share information to help keep them safe.