MHST Drop In Request Form

Drop In Request Form

The HFEH Mind's Youth Services Mental Health Support team offers a drop-in/signposting service for Young People, Parents & Teachers attending our affiliated schools. Please complete this form to request a Drop-in call with our team.
I am a: *

Young Person Parent/Carer Teacher
School Name *
This Drop-In is about: *

Me A Young Person
Non Affiliated Schools & Colleges

Unfortunatly our Mental Health Support Teams do not work within your school. Please see some alternitive services & resources below that you may find useful to contact:

Your Details
Your Name *

First Name Last Name
Contact Number *
Email Address *
Gender *
Date of Birth *

Day Month Year
Child/Young Person (CYP) Details

If you are a parent/carer please insert your child's details of your child below
Child/Young Person Name *

First Name Last Name
Child/Young Person's Date of Birth *

Day Month Year
Child/Young Person's Gender *

Your Availability

To best accommodate your Drop-In please let us know what day & time you are free for a call from our team. (If possible please choose a suggested drop in slot as advertised in our Drop in Posters)
Preferred Drop In Date & Time *

Risk Assessment

The Following Questions will help us to assess your current risk
Over the past week:
Have you felt hopeless or felt life is not worth living? *

Yes No
Have you felt you were a danger to yourself or others? *

Yes No
Have you felt at risk of harm or danger by others? *

Yes No
Have you made plans to end your life? *

Yes No
Further Information
Would you like to give us any further information about why you are contacting our service before your drop in appointment? (i.e. details of what you would like support with)

Emergency Contact Details

Please provide the details of someone else we could contact in case of an emergency
Emergency Contact Name *
Contact Number *
Please enter a valid phone number.
Relationship:
Child/Young Person GP Details
GP Practice Name *
Practice Address & Name of Doctor

Drop In Request Form