Initial Contact Form (Parent/Carer Enquiry for under 18s)
As part of your child's initial contact with Resilient Minds Highland, it would be helpful to know a few more things about them. This information will be held in the strictest confidence and will only be used to support our discussion at the initial contact meeting.
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Email *
Today's date *
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Childs First Name *
Childs Surname *
Childs Date of Birth *
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Child's Gender *
Childs Contact Telephone Number *
Childs Email Address (if they have one)
Parent/Carer First Name: *
Parent/Carer Second Name: *
Your relationship to the child *
Parent/Carer Email Address *
Childs Address & Postcode *
Parent/Carer Address & Postcode (If different from above)
Parent/Carer Telephone number (if different from above)
GP Name & Practice *
What do you hope to gain from working with Resilient Minds Highland?
 *
Have you discussed this referral with your child? *
If Yes, what does your child 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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