Enrol with Bristol Wellbeing College
You will need to enrol with Bristol Wellbeing College before we can accept you onto any workshops
Address line 1
Address line 2
What support are you receiving?
Please choose from the following options:
Have you ever received support from one of the following mental health services?
Barton Hill Settlement (ACE Service) Bristol Sanctuary Callington Road Hospital (Inpatient Team) Colston Fort (Early Intervention Service) Community Rehabilitation Service Complex Psychological Interventions Service Crisis Team Dementia Wellbeing Service Filwood Community Centre (ACE Service) Get Connected Gloucester House, Southmead Hospital (Inpatient Team) The Greenway Centre (North Assessment & Recovery Team) Individual Placement Support (IPS) service (Formerly Employment Service) Men's Crisis House NHS Talking Therapies (formerly Wellbeing Therapies / VitaMinds) Petherton Resource Centre (South Assessment & Recovery Team) The Speedwell Centre (Central Assessment & Recovery Team) Wellbridge House (Community Rehabilitation Service) Women's Crisis House None of the above Other Have you ever received support from one of the following mental health services?
Are you registered with a GP Surgery?
Which area is your GP surgery (if you have one)?
North & West Bristol (Inc. Avonmouth, Clifton, Cotham, Henleaze, Horfield, Shirehampton, Southmead) Inner City & East Bristol (Inc. Broadmead, Easton, Fishponds, Homeless Health, Montpelier) South Bristol (Inc. Bedminster, Bishopsworth, Brislington, Hartcliffe, Knowle West, Whitchurch) Different Area (Please tell us the name of your GP Surgery) I am not registered with a GP Surgery Which area is your GP surgery (if you have one)?
Inner City & East GP Surgeries
Air Balloon Surgery Beechwood Medical Practice Broadmead Medical Centre Charlotte Keel Medical Practice East Trees Health Centre (Formally Eastville and Maytree Medical Centres) Fishponds Family Practice Lawrence Hill Health Centre Lodgeside Surgery (Fireclay Health) Montpelier Health Centre St. George's Health Centre (Fireclay Health) The Homeless Health Service (Compass Health) The Old School Surgery The Wellspring Surgery
North & West GP Surgeries
Avonmouth Medical Centre (Pioneer Medical Group) Bradgate Surgery (Pioneer Medical Group) Fallodon Way Medical Centre The Family Practice Gloucester Road Medical Centre Greenway Community Practice Horfield Health Centre Monks Park Surgery Pembroke Road Surgery Ridingleaze Surgery (Pioneer Medical Group) Sea Mills Surgery Shirehampton Group Practice Southmead Health Centre (Southmead & Henbury Family Practice) Student Health Service Westbury on Trym Primary Care Centre Whiteladies Medical Group Willow Tree Surgery (Southmead & Henbury Family Practice)
South Bristol GP Surgeries
Armada Practice Bedminster Family Practice Birchwood Medical Practice Brooklea Health Centre (Nightingale Valley Practice) Crest Family Practice Gaywood House Surgery (Bridge View Medical) Grange Road Surgery Hartwood Healthcare Hillview Family Practice Lennard Surgery Malago Surgery (Bridge View Medical) Marksbury Road Surgery (Bridge View Medical) Merrywood Practice Priory Surgery Riverside Surgery (Nightingale Valley Practice) Southville Surgery (Bridge View Medical) Stockwood medical Centre Wells Road Surgery
Emergency contact details
In case of concern or emergency, please supply contact details for your next of kin or support worker:
Emergency Contact Name:
Relationship to you (eg Next of Kin/Support Worker):
Organisation (if applicable):
Please tell us about any physical or mental health support needs (eg, handouts in large print; wheelchair access).
Topics of interest
What mental health and wellbeing topics are you interested in?
Topics of Interest
Equality and diversity information
Please help us improve equality, diversity and inclusion in our service by completing the following questions
Agendered Female Genderfluid Gender non-conforming Genderqueer Intersex Male Non-binary Transgender Third gender Other (please tell us in the box below) Do not wish to disclose Gender
Do you consider yourself to be disabled?
No Yes, but prefer not to say how Yes I do, in the following areas (please tell us in the box below) Prefer not to say Do you consider yourself to be disabled?
Arab Asian/Asian British: Bangladeshi Asian/Asian British: Chinese Asian/Asian British: Indian Asian/Asian British: Other Asian/Asian British: Pakistani Black/Black British: African Black/Black British: Caribbean Black/Black British: Other Mixed: Other Mixed: White & Asian Mixed: White & Black African Mixed: White & Black Caribbean White: Irish White: Other White: English White: Gypsy White: Northern Irish White: Scottish White: Traveller White: Welsh Other (please tell us in the box below) Do not wish to disclose Ethnicity
Bisexual Gay man Heterosexual Lesbian Other (please tell us in the box below) Do not wish to disclose Sexuality
Religion / Belief
Buddhist Christian (all denominations) Hindu Jewish Muslim Sikh No Religion / Atheist Other (please tell us in the box below) Do not wish to disclose Religion / Belief
How did you discover us?
Using your information
At Second Step, protecting your personal information is very important to us and we will ensure your personal data is kept confidential and held securely.
We use a great deal of information in our
services. For example, we process information about current and past service users working with us or receiving support or tenants in our accommodation. For each service Privacy Policies will be presented directly to these individuals in an upfront way, to ensure they clearly understand how we will use their information.
To find out how we use, store and protect information obtained for these purposes please read our
[opens as a PDF] protecting your personal information leaflet