Current work situation: Tell me what you do (employed, self-employed, business owner/size, or leader). Are you managing, struggling, off sick, or returning to work? What are your main work or business worries?

Current health situation: Briefly describe your health, how it affects your work/business, and vice versa. Include the type of condition and how long you’ve had it, or if you’re awaiting diagnosis.

(Please note - This form cannot be guaranteed confidential, so only share what you’re comfortable with. Once sessions start, all information is kept in a secure, confidential records system.)

Service you are interested in: