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Mind in the Vale of Glamorgan
Mind in the Vale of Glamorgan
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Please enable JavaScript in your browser to complete this form.
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Name
*
Date of birth
*
Email
*
Phone
*
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
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Belize
Benin
Bermuda
Bhutan
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Bonaire, Saint Eustatius and Saba
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Bouvet Island
Brazil
British Indian Ocean Territory
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Burkina Faso
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Cabo Verde
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Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
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Timor-Leste
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Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
GDPR Consent
*
I consent to Mind in the Vale of Glamorgan keeping my information in the secure database in line with General Data Protection and Mind in the Vale's
GDPR Policy
Why are you referring to Mind in the Vale?
*
My GP has advised me to refer
A nurse in my GP practice has asked me to refer
I am referring myself
Which GP practice are you registered with?
*
I am receiving support from the Vale Locality Mental Health Team
What services do you require?
*
Centre of Clinical Interventions Guided Self-Help (for example, depression, anxiety, worry...)
(?)
General Wellbeing Support
(?)
What are the issues impacting your mental health that you need help with?
*
Assertiveness
Depression
Worry
Procrastination
Distress intolerance (regulating emotions)
Self-compassion
Self-esteem
Panic
Perfectionism
Social anxiety
What are the issues impacting your mental health that you need help with?
*
Physical health
Social (eg. housing, debt, benefits)
Mental health support
Education or employment
Addictions
Pain management
General wellbeing
You selected "General wellbeing" - please give us more information below.
Suitable time to call?
*
Morning
Afternoon
Comments
*
Submit
Volunteer
Donate
Your Feedback
Search our site
Home
About Us
Vision and Values
Our Trustees
Our Reports
Policies
Equality and Diversity
MQM (Mind Quality Mark)
Outcome Measures and Recovery
Our Services
Day Services and Community Opportunities
Peer Support Sessions
Guided Self-Help
Wellbeing
Counselling
Student Volunteer Counselling Placements
Training
Mental Health First Aid
Suicide First Aid
Mental Health Awareness Training
Courses
Anger Management
Re-Thinking Anxiety
ACTivate Your Life
PMHSS Courses – Stress Control
PMHSS Courses – Understanding Me
Other Services
LGBTQ+
Work With Us
Vacancies
Volunteering Opportunities
Suicide Prevention
The Mind Shop
Support Us
Fundraise for us
Our Fundraisers
Donate
A Gift in your Will
#MoveforMITV
News
Contact Us
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