TMAF Counselling

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Address line 1 (door number):
Street Name:
City:
Post Code:


Date of Birth:
Black Heritage Eligibility:
Over 18:
UK Resident:
London/Birmingham Resident:
Employment Status:
Household Income:
Receiving Benefits:
Able to Pay Bills:
Can Afford Food:
Can Afford Transport:
Can Afford Counselling:
Spoken to GP:
Current Counselling:
Previous Counselling:
Waiting List Support:
Future Optimism:
Feeling Useful:
Feeling Relaxed:
Interested in Others:
Energy Level:
Problem Management:
Thinking Clearly:
Self Confidence:
Close to Others:
Feeling Confident:
Decision Making:
Feeling Loved:
Interest in New Things:
Feeling Cheerful:
Self Harm Thoughts:
Self Harm Plan:
Currently Safe:
Safety Details:
Psychiatric Involvement:
Mental Health Admission:
Mental Health Diagnosis:
Commit 15 Sessions:
Weekly Availability:
Online Session Ready:
Application Reason:
Expected Outcome:
Allocation Notes:
Disability:
Assistance Required:
GP Contact Consent:
Alternative Pathway Consent:
Monitoring Consent:
Contact Consent:
Follow-up Consent:
Information Declaration:
UK Residency Confirmation:
Change Notification Agreement:
Accuracy Acknowledgement:
Marketing Opt-In:
Referral Source:

Driven by curiosity and built on purpose, this is where bold thinking meets thoughtful execution. Let’s create something meaningful together.

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