Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.ScreeningFirstLastIn answering the questions it is best to think of your life as it generally is now (we all have some good or bad days) We would like to ask you a few questions to enable us to measure how helpful our services are. You can choose to answer all or none of the questions, and choosing not to answer will not affect your access to any of our services in any way. When answering the questions, you could take account of the following: Name *FirstLastI experience a general sense of emptiness YesMore or lessNoI miss having people around me YesMore or lessNoI often feel rejectedYesMore or lessNoThere are plenty of people I can rely on when I have problemsYesMore or lessNoThere are many people I can trust completely YesMore or lessNoThere are enough people I feel close to YesMore or lessNoSubmit
