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Client Details

Name
Address
Contact permissons

Eligibility check

Do you/they experience mild to moderate mental health issues?
Do you/they experience money worries?
Does your/their mental health affect money management (e.g. social anxiety, overwhelm, fear of contacting people etc.)?
Are you currently NOT in mental or financial crisis?
Are you willing to engage in guided self-help?

GP Details

I give consent to contact my GP

Emergency Contact

In the event of an emergency, do you consent to us contacting your Emergency contact on your behalf:
Do you (or the client) present any risk to youself (or themselves) or our staff who will work on this project?

[OPTIONAL] Demographic details

Do you consider yourself to live with any of the following that you would like to make us aware of? (Use 'Crtl' on your keyboard to select multiple)