Surname
DOB
Email
Tel
Address
Postcode
GP Surgery
Service (please click down arrow to select a service) —Please choose an option—CounsellingWellbeing ServiceParent group - Timid to TigerParent group - Mental Health First AidParent group - Mental Health AwareParent group- Positive Parenting Programme (Triple P)Parent group - Sleep WorkshopParent group - Anxiety Workshop
Does the young person know about and consent to the referral? YesNo
Accessing another Service? YesNo
Household in receipt of benefits? YesNo
Are you happy to be added to the JDI mailing list to keep you informed of all the services we offer and when? YesNo
FURTHER INFO/COMMENTS
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Service (please click inside box below to select a service) —Please choose an option—CounsellingWellbeing ServiceTimid to TigerMental Health First AidMental Health AwareSleep WorkshopOther - please specify below
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01625 665079
07718 425405
hello@justdropin.co.uk
15 Brook Street Macclesfield SK11 7AA
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