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If you're feeling low and need to talk to somebody text SHOUT to 85258

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For General Enquiries please use the simple contact form below or email us helpme@thatsmentalmate.org.uk

Contact us any time

Name

Phone

Email

Subject

Message

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If you would like to sign up with us for assistance you can either use the more detailed assessment form below or download the form, fill it in and scan it back to us at helpme@thatsmentalmate.org.uk

Assessment form

Name:

D.O.B:

Address:

Mobile no:

Email:

Sex:

Male

Female

Transexual

Prefer not to say

Sexuality:

Straight

Bisexual

Gay/Lesbian

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Other

Other:

Ethnicity:

Are you considered disabled?

Yes

No

Do you suffer from any mental or physical health conditions? If so, please explain.

Do you believe there may be undiagnosed conditions? If so, explain why?

What is your main purpose for contacting us?

Is there anything else we could help with?

Have you worked with any other local services for your problems? If so, who?

As part of our advocacy role, we may need to share information with other services that may be able to help you. Any service that we share information with, will be relevant to your individual case and we will chat to you about this before we divulge any relevant information to third parties. Do you consent to this?

Yes

No

Are you currently under the social services team?

Yes

No

Are you currently under probation services?

Yes

No

Whilst working with us, we will always inform you about our need to share your information with other services, unless, what you divulge to us may be a cause of concern to the harm of yourself or another person. At which point, we are legally obliged to contact the police. Please tick to say you understand this.

I agree:

Print name:

Date:

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Download Assessment Form

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That's Mental Mate!

Tel: 07944415436

Email: HelpMe@ThatsMentalMate.org.uk

Halifax, West Yorkshire

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