YES! I want to come to ThroughBlue:
(All information is kept strictly confidential.)
* Required
Email address
*
Your email
Firstname and Surname:
*
Your answer
Phone:
*
Your answer
Alternative Phone:
Your answer
Which group would you like to attend?
*
Friday 12.30pm-2.30pm
Monday 6.30pm-8.30pm
Suburb:
*
Your answer
Age Range:
*
Choose
Under 25
25-34
35-49
50-65
65 +
I'd prefer not to say
How did you find us?
*
Choose
Google Search
Recommended by a friend
Flyer at library / cafe
Referral by Women's Health Collective
Referral by GP
Referral by Counsellor/Therapist
Referral from Church
Referral by another organisation
Neighbourly
Online Events Calendar
Coffee News
Community Events Notices
Radio
Newspaper
Facebook
OTHER
Special Requirements:
Please note both groups have wheelchair access, but let us know if there are any other facilities you require.
Your answer
Information for our counsellor:
WHY DO WE ASK THESE QUESTIONS?
Everyone has different needs when coming to ThroughBlue. We ask these questions so that our counsellor can provide tailored support that is right for you personally, so that you feel fully supported and looked after during your first sessions.
The questions in this section below are kept STRICTLY CONFIDENTIAL to the ThroughBlue counsellor only.
Are you able to quickly recognise the early signs of depression?
*
On a scale of 1-10 where are you? (1 is worst, 10 is best).
I don't see depression coming and it catches me out of the blue
1
2
3
4
5
6
7
8
9
10
I can see depression coming a long way off
When depression starts, do feel you have skills to manage it?
*
On a scale of 1-10 where are you? (1 is worst, 10 is best).
I would like more skills to manage depression
1
2
3
4
5
6
7
8
9
10
I have enough skills to manage depression
Do you ever feel isolated or lonely?
*
On a scale of 1-10 where are you? (1 is worst, 10 is best).
At times I feel Isolated and lonely
1
2
3
4
5
6
7
8
9
10
I don't feel isolated or lonely at all
In regards to your depression, can you talk about it easily with others?
*
On a scale of 1-10 where are you? (1 is worst, 10 is best).
No, I don't feel comfortable talking about depression
1
2
3
4
5
6
7
8
9
10
Yes, I can easily talk and share about my depression
We try to customise our workshops to meet group member's needs. What subjects would help you in your personal journey? (You can tick more than one.)
Understanding anxiety & panic attacks.
Boundaries & relationships
Self-harm & obsessive behaviours
Values, goals & behaviours
Anger & the body
Nutrition, sleep & routines
Self compassion, self care & self acceptance
Myths of domestic violence & sexual abuse
Have you seen a counsellor and are you still going?
Choose
Yes, and I'm still going to counselling.
Yes, I''ve seen a counsellor, but I've stopped going.
No, I haven't seen a counselllor.
Apart from Depression, what other Mental Health diagnoses do you have?
*
Your answer
Are you currently on any medication for mental health?
*
Yes
No
Other:
Required
Do you have any history of self-harm?
*
Choose
Never
1-3 years ago
More than 3 years ago
Yes, its something I'm struggling with currently
What are you hoping to get out of the group?
(You can also add a message and any questions you have here.)
Your answer
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