Building a Healthy Future course for people with long-term conditions - summer 23

Your Registration Info

First Name *

Last Name *

Email Address *

Phone *

Street Address *

Supplemental Address 1

Supplemental Address 2

City

Postal Code *

Long Term conditions

Do you have a long term physical condition? *

Yes No

Long-term physical condition(s)

Mental health problems- please describe

Which of these options best describe your experience of mental health problems?

I have personal experience of mental health problems	I use / have used mental health services
I care or look after someone who has mental health problems	Any other (please specify if you wish)
None of the above	Prefer not to say

What is your experience of mental health problems - If you selected other?

Where did you hear about this course? *

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