Quick Meeting Sign-in

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The information you provide in this form is confidential. We require minimal basic detail in order to be able to contact you and to understand where, when and how our services are accessed. This helps us plan support where it is most needed and enables us to keep our services free.

Confidentiality (yours, ours & others) & Behaviour *

THIS IS A PRIVATE SUPPORT MEETING: You agree:

not to record it in any way,
not to share anything from it with others,
that if you are not here for personal support, you have made this known to the facilitator AND have obtained their permission to remain,
that your attendance [in de-identified format] may be used for funder performance reporting enabling this service to be free,
that you will be respectful to others.

Full terms.

I agree

Meeting code *

3 character code that your facilitator will provide you
Facilitator code listing

Mobile *

We do not share this with anyone else. For safety reasons, we need a way to contact you.

Home postcode *

This helps us understand which locations need dedicated support

First name *

Let us know what to call you

In the last week, I have felt isolated *

3 = neutral / don't know

Strongly disagree

Strongly agree

In the last week, my situation has felt hopeless *

3 = neutral / don't know

Strongly disagree

Strongly agree

In the last week, I have felt suicidal *

3 = neutral / don't know

Strongly disagree

Strongly agree

Any other comments? (max 160 characters)

What best describes you? *

First time attendee

Returning attendee

Guest / professional (non PBB)

PBB team member (lead)

PBB team member (non lead)

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