Please tick if you are affected by any of the following Anxiety Sexual Abuse/Assault Emotional Abuse Anger Family Difficulties Sexual Identity Issues Sleeping Difficulties Academic Difficulties Family Separation/Divorce Stress Behaviour Financial Difficulties Social need (housing/finance) Bereavement / loss Health (Physical) Suicidal thoughts Bullying Physical Abuse /behaviours Substance Abuse/Addictions Depression Relationship Difficulties Trauma Domestic Violence Self-harm Eating Issues Self-worth/Self esteem Other not stated (please provide brief details) – Employment status Employed Unemployed/Student
Please tick if you are affected by any of the following Anxiety Emotional Abuse Sexual Abuse/Assault Anger Family Difficulties Sexual Identity Issues Academic Difficulties Family Separation/Divorce Sleeping Difficulties Behaviour Financial Difficulties Stress Bereavement / loss Health (Physical) Social need (housing/finance) Bullying Physical Abuse Suicidal thoughts /behaviours Depression Relationship Difficulties Substance Abuse/Addictions Domestic Violence Self-harm Trauma Eating Issues Self-worth/Self esteem Other – not stated (please provide brief details) Employment status Employed Unemployed/Student