This site may not work correctly on Internet Explorer. We recommend switching to a different browser for a better experience.
Thank you for requesting support from the Counselling & Wellbeing team. We need to ask you a few questions to help us identify you and your needs. The first part of this form is personal details. Then next part is about your data and consent.
The Student Wellbeing Services value your privacy and store your information in a responsible manner, for more information please review our University Data Policy. If you do not consent to any sharing please enter 'no' in each of the consent boxes. Please refer to Data protection rights for more information.
If you have any concerns about the use s of your data you can contact our Data Protection Officer at email@example.com or by telephone on 0118 378 8981.
Please confirm if you allow us to talk to other support contacts within Wellbeing Services & the wider University
Please confirm if you allow us to talk to support contacts outside of the University
Please enter details of your Doctor (GP) Surgery
Please enter details of your Next of Kin or Supportive Friend