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Your Choices Matter Participant Registration Form
The Your Choices Matter programme (created and managed by Elastic FM) is designed to support people who are in recovery from substance and alcohol abuse. It is not mandatory that you complete this registration form. However, the information contained within a discovery form like this one, helps us to ensure we can deliver aspects of the programme to support your unique needs, interests and preferences.  

Please think of this registration as a "getting to know you" exercise, with your best interests in mind. All information provided is confidential, kept in a manner that respects General Data Protection Regulations (GDPR) and is only accessible by a small number of trustworthy team members, who are trained in data protection matters and comply with our data protection policy for the programme. 
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Your full name *
Your mobile phone number *
Do you have dependent children? *
Your email address - if you have one
Your home address *
Are you employed? *
Are you in a relationship? *
What is your age? *
What is your date of birth? *
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Are you using doctor prescribed medication to help you? *
How long have you struggled with a dependency on alcohol or substance abuse? *
How would you describe your current status in relation to consumption of alcohol or use of drugs?  *
Please describe how your life feels to you just now.  *
What are some of your bucket list items - the things you would like to do, places you would like to visit in your life etc? *
What do you feel is preventing you from making progress with these life desires?
What are you most thankful for in your life right now?
What is the biggest regret in your life? *
What would you describe as some of your biggest personal challenges?  *
What are you most afraid of? *
What do you feel most passionate about? *
How do you like to spend your free time?  *
What would your perfect day be like? Please describe it. 
Describe what your dream life looks like?  *
Who are the people that support you most with your challenges?  *
What areas of help are you looking for?  *
How committed are you to overcome and better manage your use of alcohol/drugs? *
Acceptance: By completing and submitting this form, I agree you can contact me and send information about participating in the Your Choices Matter programme.    *
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