Mental health request

How is your sleep? *

How is your appetite? *

How is your mood? *

How are your relationships? *

Have there been any changes in your current situation? *

Are you happy with your current medication and dosage?

Yes

No

Do you feel a change in dose might help?

Yes

No

Are you engaging with Dudley Talking Therapy/Listening and Guidance/Counselling?

Yes

No

Why are you not engaging with these services? *

What can we do to assist you to engage with these services? *

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