New Service User

Please complete this Welcome Form. When you have completed it, you will receive a confirmation email which you must show to the facilitators when you attend your first Outside Edge session.

Information

First Name

Last Name

Sign me up to Outside Edge's mailing list

Yes

Receive news about our services by SMS

Yes

Phone

Email

Demographic Details

Date of Birth (DD/MM/YYYY)

Which Borough do you live in?

If you selected Borough Outside of London, please specify the borough

Postcode

What best describes your gender?

Do you consider yourself to be trans?

Trans is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth

What is your Ethnic Group?

Any Other Ethnic Group - please describe

Which of the following best describes how you think of yourself?

Do you consider yourself to be disabled?

If yes, please select any of the below which apply to you

Disability Details - Other

Other than the disabilities listed above, do you have any other health or mental wellbeing issues that you think we should be aware of?

Qualifications, Housing and Criminal Justice Details

Highest Level of Qualification

Highest Level of Qualification - Other

Current Employment Status

Current Employment Status - Other

Current Housing Situation

Current Housing Situation - Other

Yearly Income

Benefits Receiving

Benefits Receiving - Other

How recently have you had contact with the Criminal Justice System?

Substance Use

Substances I have/had problems with

If you selected Other, please specify

Alcohol - most recent use

Opiates - most recent use

Amphetamines - most recent use

Crack - most recent use

Cannabis - most recent use

Cocaine - most recent use

Other - most recent use

Personal Recovery Goals

What is/was your personal recovery goal?

Personal Recovery Goal - Other

On a scale of 0-10, how well do you feel you are doing on your recovery goal? (0 = not very well and 10 = very well)

Relationships

Below are some statements about relationships. For each, please select the extent that you agree or disagree.

I am content with my friendships and relationships

I have enough people I feel comfortable asking for help at anytime

My relationships are as satisfying as I would like them to be

Wellbeing

Below are some statements about feelings and thoughts. For each, please select the option that best describes your experience over the last 2 weeks.

I've been feeling optimistic about the future

I've been feeling useful

I've been feeling relaxed

I've been dealing with problems well

I've been thinking clearly

I've been feeling close to other people

I've been able to make up my own mind about things

About Outside Edge

What is your main reason for attending Outside Edge

Main reason for attending Outside Edge - Other

How did you hear about Outside Edge?

I attended a taster sessionI was referred by a Social Prescribing Link WorkerI was referred by a Drug & Alcohol Treatment Service WorkerOther

Please specify where

Please provide name of Worker

Please provide details

Please feel free to contact us if you require further assistance, would like this form in an alternative format or to complete this form over the phone with a friendly member of Outside Edge's team.

We will support any access requirements you may have during Outside Edge's enrolment process and please let us know if you have any access requirements before your first session so that we can support you to attend.

Contact Information
Privacy Policy