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Which option best describes you
I am under the care of mental health services in Bolton
I am under the care of mental health services in Central Manchester
I am under the care of mental health services in North Manchester
I am under the care of mental health services in Salford
I am under the care of mental health services in South Manchester
I am under the care of mental health services in Trafford
I am under the care of mental health services in Wigan
I am under the care of Child and Adolescent Mental Health Services (CAMHS)
I use Primary Care Psychological Therapy Services (often referred to as IAPT)
I use Specialist Community Psychological Therapy Services (e.g. Military Veterans Service, Eating Disorder Service, Perinatal Community Mental Health Team)
I use Health and Justice Services
I am a patient in Adult Forensic Services
I am a patient in Rehabilitation Services
I am a patient in the Mental Health and Deafness Unit (John Denmark Unit)
I use Addiction Services
I support someone with mental health/addiction difficulties as a friend or family member
I am a professional who works in the voluntary sector
I am a professional who works in the statutory sector
I am a professional who works privately for myself/private organisation
Background Information – Strictly Confidential (Monitoring Purposes Only)
Do you have any special requirements that you think we should be aware of e.g. special needs, large print course materials, disabled access, requirement for one to one support help to define long term goals?
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Monitoring Information – Strictly Confidential (Optional)
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Do you consider yourself to have a physical or mental health condition or disability?
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Which of the following best describes your ethnic background?
Asian or Asian British – Bangladeshi
Asian or Asian British – Pakistani
Asian or Asian British – Indian
Asian or Asian British – Any other Asian background
Black or Black British – African
Black or Black British – Caribbean
Black or Black British – Any other Black background
Mixed – White & Asian
Mixed – White & Black African
Mixed – White & Black Caribbean
Mixed – Any other Mixed background
White – British
White – Irish
White – Any other White background
Other Ethnic Group – Chinese
Other Ethnic Group – Any other Ethnic group
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