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Email address

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First name

Last name

City/town

Country

Age Group

Location

Your Mobile Number

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship

Which of the following best described your ethnicity?

How did you hear about BeWell@StepOne?

Do you consider yourself to have a disability?

Do you have any disabilities, health conditions (mental or physical), or additional needs that we should be aware of to provide appropriate support? If yes, please provide details (Optional):

Are you currently receiving support from any other mental health services? If yes, please provide details (Optional):

Are you currently on a waiting list for any Mental Health services?

Is there any additional information we should be aware of to better support your engagement and ensure the safety of yourself and others? If yes, please provide details (Optional):

I consent for BeWell@StepOne to contact me for feedback and case studies

By ticking this box, you consent to StepOne storing and processing your personal information in accordance with the UK General Data Protection Regulation (GDPR). Your data will be stored securely and used only for the purposes of providing and improving our Peer Support Groups and related services. We will not share your information with third parties without your explicit consent, except where required by law. You have the right to access, amend, or request the deletion of your data at any time. For more information on how we handle your data, please refer to our Privacy Policy or contact us at BeWell@steponecharity.co.uk. By ticking this box, you confirm that you have read and understood this agreement.

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