Your details
First name
(Required)
Last Name
(Required)
Preferred name (if different)
Date of birth
(Required)
Current address
(Required)
Email address
(Required)
Telephone number
(Required)
Preferred way of being contacted
(Required)
please select
Telephone call | Text | WhatsApp
Email
By letter to current address
Please tell us which emotional difficulties/issues you would like TESS to help you with.
(Required)
Confidence and self-esteem
Relationship difficulties
Past experiences
Anger difficulties
Low mood
Anxiety
Other
Select all that apply
What do you hope will be different as a result of accessing our service(s)? e.g. what are your goals for accessing our service(s)
How did you hear about our service?
(Required)
please select
Word of mouth
Personal advisor
Children’s Trust Website
Professionals
Other
If other, tell us how.
Is it okay for us to tell your personal advisor that you have referred yourself to TESS?
(Required)
please select
Yes
No
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