Workshop Registration Form for Hillingdon Talking Therapies

Thank you for your interest in our workshops.

As an NHS service we are required to collect information to ensure our support is reaching everyone in the borough of Hillingdon.

To register for a one-off workshop, you will be asked to complete a questionnaire. This can give you and us a good indication of any symptoms you may be experiencing and, hopefully, through the session you are attending, you can learn ways to improve these.

All information is kept confidential and will not be shared with any other organisation.

If you have any further questions about this or on how to complete this form please do not hesitate to contact us on 01895 206800 or via email at cnwl.hillingdontalkingtherapies@nhs.net 

Please remember to click the submit button once you complete this form in order to send it through to the service.

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PHQ-9

Over the last two weeks, how often have you been bothered by any of the following problems?

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GAD-7

Over the last two weeks, how often have you been bothered by any of the following problems?

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Phobia scales

Put a number next to the situations or objects below to show how much you would avoid it. 0 being you would never avoid it to 8 being you would always avoid it.

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Work and Social Adjustment

People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate your problems look at each section and determine on a scale how much your problem impairs your ability to carry out the activity. With 0 being "not at all" to 8 being "very severely."

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Additional note about GP contact: Through completing this form you are consenting to have this information stored confidentially on a secure electronic system separate from your GP’s system. If we are concerned about your safety, we may contact you or your GP regarding this.

Our Talking Therapies Services are not able to provide immediate support in an emergency. If you require immediate help please contact your GP, or your local Accident & Emergency Department, or call the Urgent Advice Line on 0800 0234 650 open 24 hours.