A Father's Child Services CIC

Do you give us consent to store and use your information in line with GDPR/Data Protection Principles to provide our services? *

A Father's child Services CIC Services. What service are you making a referral to? *

Do you have any other support in place? E.G. Social Worker, another organisation *

Circumstances we should be aware of, E.G. NEET (Not in Employment, Education or Training) *

Have you ever used A Father's child Services CIC services? *

Has anyone related to you/affiliated with you used A Father's child Services CIC services? *

Do you know anyone that works at A Father's child Services CIC? *

How enthusiastic are you/the person you are referring with wanting to make change? Use the below scale *

Do you class your self as being affiliated with a gang? *

Have you been experiencing Low Moods? *

Have you been given a clinical diagnosis by a GP or Specialist? *

Self Harming Thoughts/Behaviours *

Suicidal Thoughts/Feelings? *

Worries around behaviours with Food *

Have you spoken to anyone about how you are feeling? *

If yes, have you been tested? *