Booking Psychology Enhanced Engagement Team (PEET)

Psychology Enhanced Engagement Team - Booking Form

Personal Details

Name(Required)

Title First name Surname

Date of birth(Required)

What is your gender?(Required)

What is your ethnicity?(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address Details

Address(Required)

Street Address Address Line 2 City Postcode

Your GP Practice

Your GP Practice(Required)

Please can you briefly describe the current difficulties you are experiencing? (e.g. what your difficulties are; how long they have been present; and how they affect your daily life).(Required)

Please can you tell us what you would hope to gain from engaging with the Psychology Enhanced Engagement Team (PEET)?(Required)

Please can you inform us if you have any involvement with any mental health professionals or counselling services?(Required)

How did you hear about us?

Phone

This field is for validation purposes and should be left unchanged.