About the Workshop Registration form

Harrow Talking Therapies offer workshops to help people manage a number of problems such as worry, low mood, stress and more. Our workshops are delivered by trained Psychological Wellbeing Practitioners and Psychological Therapists.

As an NHS service, we are obliged to take the following information to ensure our support is reaching everyone in the borough of Harrow. The questionnaire on this page can give you and us an indication of your current mental wellbeing. This will help us to ensure the workshop will be supportive to your needs.

All the information you provide is kept confidential and will not be shared with any other organisation. If you have any further questions about this, please do not hesitate to contact us on 020 8515 5015 or by email at harrow.iapt@nhs.net.

We look forward to speaking to you soon.

Please remember to click the submit button once you complete the form below in order to send it through to the service.

Are you on the wrong page? If you are referring yourself for individual/group therapy, please click on this link instead.

Workshop Registration Form for Harrow Talking Therapies

Disclaimer

Webinars are now recorded. Please note, only the presenter is being recorded and not the attendees. Contact information and names are only available to our service and not other participants.

Sign up timeframe

On the day of the webinar, participants must sign up before 3PM to be guaranteed zoom link.

Date completed Required

Which workshop would you like to attend? Required

Harrow Talking Therapies – Thursday 4th April 4:30-5pm - Online mindfulness drop-in session

Harrow Talking Therapies - Thursday 11th April 4:30-5pm - Online mindfulness drop-in session

Harrow Talking Therapies – Thursday 18th April 4:30-5pm – Online mindfulness drop-in session

Harrow Talking Therapies - Thursday 25th April 4:30-5pm - Online mindfulness drop-in session

What is your surname? Required

What are your forenames? Required

What is your date of birth? (dd/mm/yy) Required

What is your postcode? Required

What is your gender? Required

What is your ethnicity? Required

Please provide us with a contact number for you Required

Please provide us with an email address for you Required

PHQ-9

Over the last two weeks, how often have you been bothered by any of the following problems?

Q1. Little interest or pleasure in doing things Required

Q2. Feeling down, depressed, or hopeless Required

Q3. Trouble falling or staying asleep, or sleeping too much Required

Q4. Feeling tired or having little energy Required

Q5. Poor appetite or overeating Required

Q6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down Required

Q7. Trouble concentrating on things, such as reading the newspaper or watching television Required

Q8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual Required

Q9. Thoughts that you would be better off dead or of hurting yourself in some way* Required

Please Note

* If you are experiencing thoughts that you would be better off dead or of hurting yourself in some way we would encourage you to contact your GP, or your local Accident & Emergency Department, or call the Urgent Advice Line on 0800 0234 650 open 24 hours.

There is always someone willing to help. Please don’t be afraid to ask if you need it.

GAD-7

Over the last two weeks, how often have you been bothered by any of the following problems?

Q1. Feeling nervous, anxious or on edge Required

Q2. Not being able to stop or control worrying Required

Q3. Worrying too much about different things Required

Q4. Trouble relaxing Required

Q5. Being so restless that it is hard to sit still Required

Q6. Becoming easily annoyed or irritable Required

Q7. Feeling afraid as if something awful might happen Required

Work and Social Adjustment

People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate your problems look at each section and determine on a scale how much your problem impairs your ability to carry out the activity. With 0 being "not at all" to 8 being "very severely."

Work Required

Home management – Cleaning, tidying, shopping, cooking, looking after home/children, paying bills etc Required

Social leisure activities - With other people, e.g. parties, pubs, outings, entertaining etc. Required

Private leisure activities – Done alone, e.g. reading, gardening, sewing, hobbies, walking etc. Required

Family and relationships– Form and maintain close relationships with others including the people that I live with. Required

Phobia scales

Put a number next to the situations or objects below to show how much you would avoid it. 0 being you would never avoid it to 8 being you would always avoid it.

Social situations due to a fear of being embarrassed or making a fool of myself Required

Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness) Required

Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying) Required

Our Talking Therapies Services are not able to provide immediate support in an emergency. If you require immediate help please contact your GP, or your local Accident & Emergency Department, or call the Urgent Advice Line on 0800 0234 650 open 24 hours.

Welcome to Harrow Talking Therapies and thank you for your interest in attending one of our workshops.