Initial Contact Form
As part of your initial contact with Resilient Minds Highland, it would be helpful to know a few more things about you. This information will be held in the strictest confidence and will only be used to support our discussion at our initial contact meeting.
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Today's date *
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First Name *
Surname *
Contact Telephone Number *
Email Address *
Address & Postcode *
Gender *
Date of Birth *
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Next of Kin/Emergency Contact Name & Relationship to you:
Next of Kin/Emergency Contact Telephone Number
GP Name & Practice *
What do you hope to gain from working with Resilient Minds Highland?
 *
To ensure you are adequately informed about what to expect from Resilient Minds Highland Services, Please confirm that you have read the RMH Terms & Conditions. 
(We can discuss any questions or concerns about these at our initial appointment.)
 *
Required
Preferred Date Time of initial contact (this will be arranged online on Zoom) - Please tick all that apply
12noon - 12.30pm
12.30pm - 1pm
5.30pm - 6pm
6pm - 6.30pm
4.30pm-5pm
8pm - 8.30pm
Monday
Tuesday
Wednesday
Thursday
Sunday
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Where did you hear about Resilient Minds Highland? *
Please add anything else that you think would be helpful for me to know.
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