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Be Well Clinic - Application form for paid support

We are so pleased that you're seeking out support - you are never alone.
 
To make sure you get the right support, please know that Be Well is not a helpline so it’s important that you take the right next step.
 
If you recognise the need for urgent medical attention or support, please don't wait: 
  • Call the emergency services on 999 for urgent medical support.
  • Call the Samaritans if you are in emotional distress or struggling to cope - they have a 24/7 helpline - call: 116 123
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If you recognise the need for non-urgent support, please do continue. This survey is collated via SurveyMonkey. You do not need to pay or create an account to submit this form.
1.I understand that Be Well is not a helpline and can only assist with non-urgent enquiries. (Required.)