‘we are here’ – sias€¦ · web view · 2014-12-02eleanor cuthbert-edkins (s13164152)...

SIAS Campaign 2015/16

Eleanor Cuthbert-Edkins S13164152

ContentsThe Client........................................................................................................................................2Research...........................................................................................................................................3Campaign.........................................................................................................................................5

Objectives................................................................................................................................6Target audiences......................................................................................................................7Target media............................................................................................................................8Key messages...........................................................................................................................9

PR Strategy....................................................................................................................................10Press Releases........................................................................................................................10

‘We are here’.................................................................................................................................10Big voice, making a big change.....................................................................................................11SIAS promise to ‘be there’ for their patients.................................................................................12

Events....................................................................................................................................13Seminar for medical practitioners..................................................................................................13‘We Are Here’ away days..............................................................................................................15

Social Media..........................................................................................................................16Facebook........................................................................................................................................16Twitter............................................................................................................................................16

Rosie O’Sullivan – Cross media product...............................................................................17Timeline.........................................................................................................................................18Budget............................................................................................................................................19Measurements................................................................................................................................20References......................................................................................................................................21Appendices....................................................................................................................................22

Appendix 1.............................................................................................................................22Appendix 2.............................................................................................................................25Appendix 3.............................................................................................................................27

1


The Client

Solihull Integrated Addiction Services (SIAS) work to offer easy access to support and treatment

for anyone who is battling with drug or alcohol addiction.

SIAS is one of the leading organisations in the Midlands, offering services to adults whose drug

or alcohol use has become problematic; as well as providing support for their friends and

families.

Many people find it difficult to admit that they have a problem and therefore avoid entering

treatment; while it has also been highlighted in research that many children living with parental

substance abuse are reluctant to talk to an adult who can help for fear of being taken away from

their parents and placed into care.

SIAS are committed to working, as a partnership, to ensure those who make the difficult decision

to enter treatment get the highest quality of support for both themselves and their friends and

family. It is crucial that the public recognise SIAS as a trusted body, who will help addicts on

their way to becoming and remaining drug and alcohol free, this is something that is at the heart

of the campaign.

2


Research

In ‘Support for families where a parent has alcohol problems’ (see appendix 1), a document

published in ‘Community Care’ (2008), the importance for services to work closely with families

affected by alcohol and drug abuse is highlighted throughout.

Many parents battling drug or alcohol addiction ‘fear and experience “discriminatory responses

from local and professional communities”’ (Anonymous, 2008) which is said to have a negative

impact on the parents’ overall mental health and wellbeing.

This is just one reason why it is important for SIAS to not only present themselves as a trusted

organisation but also to provide a friendly environment for families, where children feel they can

be honest about the difficulties of living with parental alcohol abuse in particular.

The document also suggests that a holistic approach to treatment, and a move away from

focusing on the individual rather than the family context, would benefit both parents dealing with

alcohol and drug abuse (in particular binge drinking) and their children. This is more likely to

ensure parents remain alcohol and drug free, while also setting SIAS apart from other

organisations, which in turn could increase the number of people choosing SIAS as their

preferred treatment clinic.

Joy Barlow also published a document in ‘Community Care’, entitled ‘Parental alcohol misuse’

(see appendix 2), which argues that ‘alcohol is no ordinary commodity’ and that ‘its impact on

our lives and on our families, is habitually underplayed’ (2011). This gives evidence supporting

the need for a campaign such as the one outlined in this proposal and indicates a need for doctors

and medical practitioners to work closely with organisations such as SIAS in order to elevate the

importance of the fight against parental binge drinking.

In 2013, Laura Donnelly, health correspondent for the telegraph, reported that there had been a

rise in medication to treat alcoholism of 73 per cent since 2003. She then went on to state that the

number of hospital admissions related to drinking had doubled in the same period (Donnelly,

3


2013). Further to this, the National Association for Children of Alcoholics (NACOA) found that

‘children are particularly affected [by parental alcoholism], since alcohol becomes the drinker’s

priority, often to the detriment of parental responsibilities’(n.d).

As a result of these findings, a large part of the campaign will focus on rebuilding the

relationships affected by parental alcoholism and presenting SIAS as a safe environment for

those who are battling alcoholism indirectly.

4


Campaign

This campaign has been tailored specifically to meet SIAS’s needs and will aim to achieve the

following goals:

- Establish SIAS’s reputation as an expert and effective provider of drug and alcohol

treatment services

- Set SIAS apart from other treatment providers, in turn encouraging people to enter

treatment

- Ensure that all who might need to know about SIAS are aware of it and what it has to

offer

- Encourage local doctors and medical professionals to direct addicts and their

families/friends to SIAS to benefit from holistic methods of treatment

5


Objectives

As outlined by SIAS in the brief, the objectives of the campaign are as follows:

1. Encourage local people affected by drug and alcohol addiction to go to SIAS for

advice and/or treatment.

SIAS have outlined in the brief that they wish to increase the number of people

entering treatment. The more people who enter treatment with SIAS the better

their reputation will become, increasing their status as an official, trusted body.

2. Increase awareness of SIAS and the services they have to offer – present SIAS to the

public as experts

SIAS’s services range from drug awareness training to needle exchanges. It is

important that SIAS are presented to the public as an expert organisation, offering

a range of services, as this will have a direct effect on the number of people who

enter treatment.

3. Raise awareness of SIAS’s unique treatment methods to encourage families/friends

indirectly battling addiction to seek help and/or advice from SIAS

As part of the ‘We Are Here’ campaign, we are proposing quarterly events to

improve the family relationships that may have been affected by addiction, which,

as indicated through research, will increase the chances of full rehabilitation. This

is a unique initiative and will almost certainly have a direct effect on the other

objectives, positioning SIAS as a forward thinking, creative organisation.

6


Target audiences

Given the nature of the campaign it is important to get medical professionals on side and

recognising SIAS as the best organisation to provide independent addiction treatment and advice.

For this reason, the campaign will target local doctors and medical practices in order to gain their

support and encourage them to refer patients to SIAS for treatment and/or advice.

As highlighted through our research, the importance of encouraging families and children who

are indirectly affected by alcohol and drug abuse (particularly by parental binge drinking) to seek

help and advice from an organisation like SIAS is growing, therefore a large part of the

campaign will focus on encouraging them to contact SIAS in the first instance.

In order to increase awareness of SIAS and the services they offer it is imperative that the local

community are made aware of them – this group will be one of the major audiences targeted by

the campaign. It is also important that people are encouraged to utilise the services offered by

SIAS and not feel intimidated and at risk of being negatively judged, therefore those battling

addiction personally will be at the heart of the campaign, in order to encourage them to enter

treatment and chose SIAS as their preferred treatment provider.

7


Target media

As the local community, and those affected by addiction in the Midlands, are at the heart of the

campaign the media targeted will be Solihull and Midlands based. Please see below a sample

distribution list for press releases.

Birmingham Mail

Jim Cartledge (Assistant Content Editor)

[email protected]

Solihull News

David Irwin (Reporter)

[email protected]

Drug and Alcohol Addiction Recovery Magazine

However, we recognise the importance of getting medical professionals and doctors on side to

ensure the success of SIAS’s portrayal as experts in the treatment of drugs and alcohol. For this

reason a number of trade publications will also be targeted, please see the distribution list sample

below.

Drink and Drugs News

David Gilliver (Reporter)

[email protected]

Drug and Alcohol Addiction Magazine

New Doctor

Stella-Maris Zegge (Press Officer)

[email protected]

8


Key messages

In order to achieve the aforementioned objectives, it is important that a number of key messages

are communicated through the campaign. Firstly it is important that it is indicated to the public

that SIAS are experts and should be the first port of call for drug and alcohol advice, as well as

the most trusted local provider of addiction treatment.

Following some in depth research into current methods of treatment, it is clear that concentration

on the individual alone is no longer guaranteed to be successful and a focus on the family context

of the individual is paramount. For this reason it is important to communicate to the public that

SIAS provides a safe family environment, supporting those indirectly affected by drug and

alcohol abuse as well.

It was also highlighted from our research that the subject of binge drinking among parents is not

something which is as seriously addressed as drug abuse. For this reason, a large part of the

campaign will focus on ways to introduce holistic methods of treatment to tackle this particular

area of addiction and will aim to indicate to the public that SIAS are leaders in this field and

should be their preferred provider of such treatment.

9


PR StrategyPress Releases

‘We are here’

Solihull Integrated Addiction Services (SIAS) are changing the way they are approaching

addiction treatment, focusing on the family context of patients and supporting those indirectly

affected by drug and alcohol abuse also.

SIAS is a partnership of organisations, based in Solihull, and is dedicated to providing advice

and treatment for people in the Midlands who are battling drug and alcohol addiction. 2015 will

see SIAS taking a new and unique approach to treatment, which they argue is “completely

necessary to ensure full recovery for our patients”.

“We have done a great deal of research into how we can become front runners in the treatment of

drug and alcohol abuse. There is a growing importance of focusing on families and friends of

addicts as well as the individual; this is something that our ‘We Are Here’ programme works to

achieve. Through away days and team building exercises – funded by ourselves and through

donations – we are working to mend relationships which may be struggling as a result of

addiction.”

The organisation have even enlisted the help of local songstress Rosie O’Sullivan, who will be

donating 5p from every sale of her debut album ‘Now You See Me’, released spring 2015, in

order to raise awareness and funds for the initiative.

If you would like to find out more about SIAS and the services that they offer, or even if you

would like to contribute to the life changing work they carry out every day, visit their website at

www.freedomfromdrugs.com.

Notes to editor

10

http://www.freedomfromdrugs.com/


SIAS’s current focus is on parental alcoholism, for more information contact 0121 678 4730

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Big voice, making a big change

Sutton Coldfield born Rosie O’Sullivan is set to help the lives of a number of families in the

West Midlands by donating 5p from every sale of her debut album this spring to Solihull

Integrated Addiction Services’ programme supporting families dealing with parental alcohol

abuse.

20 year old Rosie first made a name for herself when she reached the live finals of Britain’s Got

Talent 2013. “The show was such a great platform for me and has given me the opportunity to

live out my lifelong dream” said Rosie.

5p will be donated from every sale of her debut album, which will feature both original and

cover tracks in the soul style that gained the young songstress her notoriety.

“Growing up I came across people from all walks of life and I feel that this opportunity should

not only benefit me but also those less fortunate. SIAS is a really great organisation and this

programme will help so many parents and their children and I feel blessed to be a part of it.”

The programme will look to rebuild relationships under strain between parents battling alcohol

addiction and their children. “This is a new approach to treating addiction, but after a great deal

of research there is definitely a call for a holistic approach to tackling this problem” said a

representative from SIAS. The money raised will be used to help fund the pilot event for the

programme, which if successful will hopefully become a regular fixture in SIAS’s calendar.

Do you want to help change lives? You can do your bit by simply purchasing Rosie’s debut

album ‘Now You See Me’, out spring 2015 and a donation will be automatically made to SIAS.

Or visit www.freedomfromdrugs.com and find out more about SIAS and their services.

Notes to editor

Please contact [email protected] for images of Rosie and interview opportunities.

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mailto:[email protected]

http://www.freedomfromdrugs.com/


SIAS promise to ‘be there’ for their patients

Solihull Integrated Addiction Services, Solihull’s leading treatment provider for substance abuse,

are launching their new ‘We Are Here’ campaign this year; which will focus on the family

context of those dealing with addiction, and provide support for those indirectly affected by

substance abuse.

“After a great deal of research it came to our attention that in order to ensure full rehabilitation,

providers like ourselves should work to help the family context of addicts as well as supporting

the individual” said a spokesperson from the organisation. “This campaign will look to spread

awareness of the importance of entering treatment, in turn encouraging young people to seek

advice from our well-trained, friendly and trusted staff.”

‘We Are Here’ away days form part of the organisations 2015 campaign which highlights this

fact, and will work to encourage young people to engage with organisations like SIAS, rather

than suffering in silence.

SIAS are a partnership committed to providing advice and treatment to people battling addiction

in the West Midlands. They provide a range of services, from drug awareness training to needle

exchange, and the new holistic method will be a great addition to their already established

repertoire.

The organisation are inviting local medical professionals to a seminar, exploring the importance

of family relationships to addicts as well as giving an insight into what else their ‘We Are Here’

campaign has to offer. The event will take place at The Studio (Canon Street Birmingham B2

5EP) on February 18th 2015, for information contact 0121 678 4730.

Notes to editor

SIAS’s initial ‘We Are Here’ day will focus on helping those battling parental binge drinking.

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Events

Seminar for medical practitioners

Research shows that there needs to be more of a focus on the family context of addicts to ensure

complete rehabilitation. Treating addiction through holistic methods and focussing on rebuilding

family relationships affected by drug and alcohol abuse positions SIAS as front runners in the

fight against addiction.

It is important that doctors and other medical professionals are aware of why SIAS’s approach to

addiction treatment is a ground-breaking one and are well educated and able to refer patients

where necessary; for this reason a seminar will be held for local medical professionals at the very

beginning of the campaign.

In keeping with the goals of the campaign, medical professionals from around the West

Midlands will be invited to a seminar hosted by SIAS. Medical practices from areas where drug

and alcohol abuse is a major concern will be invited, along with the largest practices from each

town in the West Midlands.

The venue for the seminar will be The Studio (Canon Street Birmingham B2 5EP) a modern,

contemporary space perfect for a relaxed yet conducive environment to educate delegates on the

importance of SIAS’s ‘We Are Here’ initiative. Located at the heart of the city, the venue

provides a central meeting point for attendees from around the West Midlands as it is located

within walking distance of all three of Birmingham’s main train stations making it easily

accessible for all.

As the purpose of the seminar is to inform attendees of the elements of the campaign, namely the

family away days proposed, members of the SIAS team will be the main speakers giving an

insight into why SIAS has decided to make the decision to move away from focussing treatment

on the individual, working to improve the whole family context.

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A spokesperson from Welcome – a charity who are part of the SIAS partnership – will also be

organised to speak at the seminar. As Welcome deal with families they will be able to give an

insight specifically into how such a programme will benefit those directly and indirectly affected

by drug and alcohol abuse.

Upon arrival delegates will be offered branded pens and notepads in a hope that these will be

used beyond the seminar and will act as a trigger for doctors and medical professionals to

become familiar with SIAS as the leading Midlands addiction treatment provider.

Please find a breakdown of the budget for this event at page 19.

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‘We Are Here’ away days

Research has shown that there is a needto focus on the family environment of those battling

addiction in order to guarantee complete rehabilitation. As previously mentioned in the

document, Joy Barlow has found that ‘alcohol is no ordinary commodity’ and that ‘its impact on

our lives and on our families, is habitually underplayed’ (2011); for this reason, we propose that

the first ‘We Are Here’ away day should focus on families who are affected by alcohol abuse.

The purpose of the away day is to encourage young people and families to seek support from

SIAS, offering a fun activity, which sets the organisation apart from other treatment providers.

However, the event also provides a less formal platform for SIAS staff to counsel and treat

families,helping tomend broken relationships and establish coping methods for those dealing

with parental binge drinking.

Go Ape, in Cannock, is a tree top assault course. They organiseteam-building days where

attendees have full use of the assault course. On site catering facilities and other activities, make

it the perfect venue for the first ‘We Are Here’ event, as SIAS staff will be able to focus on the

families in attendance.

Please find a breakdown of the budget for the event on page 19.

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Social Media

Research has highlighted that many young people who are indirectly affected by alcohol and

drug abuse are reluctant to reach out to organisations that can provide the help and support that

both they and their parents need.

In keeping with one of the key messages of the ‘We Are Here’ campaign –presenting SIAS as a

safe family environment and the first port of call for advice and treatment – it is important to

develop an online presence in order to engage young people.

By using Facebook and Twitter to communicate upcoming events and to inform people of the

services SIAS has to offer, the organisation will become more accessible to young people and

will encourage them to seek help from SIAS if they need it.

Facebook

Facebook will also provide another less formal platform for young people to get in touch with

SIAS. Communicating with SIAS’s professionals online is a lot less intimidating for those who

find it difficult discussing their issues or fear getting their parents into trouble; giving the

opportunity for SIAS to communicate directly to young people that they are a trusted

organisation and provide a safe environment for treatment.

Twitter

‘We Are Here’ away days are a way for young people to rebuild relationships with their families,

which may have been put under strain as a result of addiction. In the lead up to the first event,

and throughout the year, to raise awareness and generate interest the hash tag #WeAreHere will

be used on Twitter.

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Rosie O’Sullivan – Cross media product

Rosie O’Sullivan is a Birmingham born artist, who first made her name when she reached the

live finals of the popular TV show Britain’s Got Talent. After a busy year, Rosie is readying

herself for the launch of her debut album in spring 2015.

Rosie grew up surrounded by people from a range of backgrounds, some who were directly

affected by the troubles linked with battling addiction. Even when at school, Rosie always

wanted to use her talent to help others and fame came very much secondary to that; for this

reason Rosie has agreed to donate 5p from every copy of her debut album sold to SIAS.

The money raised will initially go towards helping with the long term funding of ‘We Are Here’

away days, in the hope that these will become more regular than quarterly events, increasing the

number of families who will benefit from the new method of treatment.

As Rosie already has an established fan base (with 3,301 followers on Twitter and 2,866 likes on

Facebook) having her as a public supporter of the organisation is a great way of increasing

awareness in the Midlands and beyond. This initial agreement with Rosie provides a great

platform for SIAS to develop a relationship with her and her management, which could lead to

opportunities for Rosie to become an advocate of SIAS as her career progresses.

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Timeline

19


Budget

Consultancy time (1 day per week for campaign year) - £530 per day

£25440

Press releases (inc research time) - £270 per day

£1620

2400 word web journalism (Facebook and Twitter) - £6480

Seminar costs

Venue hire (The Studio, Birmingham)

Inspire theatre – approx 60 delegates

Catering (provided on site)

Speakers £1750

‘We Are Here’ pilot

GoApe tree top assault course package

10 families, 4 SIAS staff

Catering (provided on site) £1750

Transport

Coach £320 approx.

Total - £37,360

Income of 5p per sale of ‘Now You See Me’

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Measurements

At the heart of the campaign is the objective of getting more people to enter treatment with

SIAS. In order to gauge whether the campaign has been successful in increasing the number of

people choosing SIAS as their treatment provider, patients will be required to complete a short

questionnaire when registering (see appendix 3).

Question two asks how the patient found out about SIAS, presenting a multiple choice which

indicates a number of aspects of the campaign; this method also allows us as the PR consultant to

establish which methods are most successful and review the campaign accordingly.

Following the pilot ‘We Are Here’ away day, attendees will be asked to take part in a focus

group to determine how successful they found it. It is important that the focus group is an

extension of the less formal setting of the event, in order to present SIAS as a friendly

environment providing help and support to families.

During the focus group the leader should explore; what aspects of the day both parents and

children enjoyed, whether they feel that it was more beneficial than formal counselling and

whether it is something they would be keen to be involved with again (and in turn advocate to

others).

As this is a new method of treatment, which also acts as a strategy to encourage family and

young person engagement with SIAS, and will be pitched to local medical professionals it is also

important to establish how those who attended heard about the programme. This will allow us to

work out whether, following the seminar, medical professionals are advocating the scheme.

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References

Support for families where a parent has alcohol problems. 2008. Community Care, (1708), pp.

24-25.

BARLOW, J., 2011. Parental alcohol misuse. Community Care, (1869), pp. 32-33.

LAURA DONNELLY. (2013). Huge rise in numbers r=treated for alcoholism. Telegraph.

Available at: Telegraph.co.uk. http://www.telegraph.co.uk/health/healthnews/10089352/Huge-

rise-in-numbers-treated-for-alcoholism.html (30th May 2013)

NACAO. (n.d). Research. National Association for Children of Alcoholics. Available at:

NACAO.org.uk http://www.telegraph.co.uk/health/healthnews/10089352/Huge-rise-in-numbers-

treated-for-alcoholism.html (n.d)

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http://www.telegraph.co.uk/health/healthnews/10089352/Huge-rise-in-numbers-treated-for-alcoholism.html





AppendicesAppendix 1

THE EVIDENCE BASE FOR SOCIAL CARE PRACTICE

Each week the Social Care Institute for Excellence analyses research findings behind specific

social work practices

Balancing the rights and needs of both the children and adults in families where a parent has

alcohol problems can pose difficult dilemmas. Most parents want to do their best and those with

alcohol and mental health problems are at times acutely aware of the effect of their illness or

alcohol misuse on their children. Research from Scie shows that adults' and children's services

need to work closely together in order to ensure the best outcomes for families.

A significant number of parents in contact with social services have problems with alcohol or

drugs, or both, and some of them are putting their children at risk. The Advisory Council on the

Misuse of Drugs found that, on average, parental problem drug or alcohol use featured in a

quarter of cases of children on child protection registers. Other research suggests "hidden"

problems make this a far higher number.

Even though parents may be aware that they are in need of support, they can be reluctant to seek

it. Parents receiving services through the care programme approach and their children said they

feared and experienced "discriminatory responses from local and professional communities and

agencies that may lead to family separations or child protection procedures."

The researchers concluded that these fears can adversely affect parents' mental health and well-

being over time.

Children living with parental alcohol abuse told Childline that they were reluctant to share

problems with adults who could help because of fear that they would be taken away from their

families. The secrecy and stigma associated with alcohol and drug misuse can mean that parents

23


are not getting the support they need and some children are living in situations where they may

be at risk but they are not known to social services.

Most research shows that what upsets children most is not parental drinking, or even parental

drunkenness, but the conflict between their parents that often results from drinking and disrupts

family life. Physical abuse was identified as the main problem for four out of 10 children living

with parental alcohol abuse who called Childline. The absence of a parent because of separation,

divorce or a prison sentence is also a factor that will have a direct negative impaa on children. So

too does the poverty and poor housing that can accompany substance misuse.

The research also shows that a parent's substance misuse may not be the most important factor

affecting a child's life. Other events, such as the death of a close relative or a serious family

illness, may cause a child more worry than a parent's alcohol problem.

However, where there is serious parental drug or alcohol misuse and children cannot remain with

their parents, anecdotal evidence shows that they are increasingly being placed with friends and

family, with grandparents often being the relatives who agree to take on the care of the children.

In addition, arrangements are made privately between family and friends, although the number of

these is unknown.

Although "kinship care" is associated with greater stability for children and better continuity in

terms of family and cultural issues than foster care, there is also evidence that kinship carers are

likely to experience greater economic difficulties and provide poorer accommodation than

nonkin foster carers.

Research shows that there has been service development in supporting parents who have drug or

alcohol problems over recent years, but, despite the policy framework provided by Models of

Care and Working Together to Safeguard Children, many drug and alcohol treatment services

still focus on individuals and not on the family context in which they are living. There needs to

be a wider recognition of the role that families play in supporting individuals and their role in

24


recovery and closer working between services that support adults and those that support children

and families.

25


Appendix 2

Community Care and Community Care Inform examine how children, young people and the

entire family environment are affected. By Joy Barlow

Research shows that parental alcohol misuse can have a considerable negative effect on children,

young people and die family. Children growing up in households where alcohol use is

problematic often do not achieve their full potential in life. They may have low self-esteem, feel

unsafe and find it difficult to engage in relationships, illustrating a lack of trust often into

adulthood. Such profound effects may impact on the five outcomes of die Every Child Matters

framework.

In addition, alcohol misase is often hidden by parents, by family members and by children

themselves. This can have serious consequences for children, including (but not limited to) poor

educational attainment, emotional difficulties, neglect, abuse and taking on inappropriate caring

responsibilities. Alcohol misuse is also linked with family disharmony and violence.

"Parental alcohol misuse damages and disrupts die lives of children and families in all areas of

society, spanning all social classes; it blights the lives of whole families and harms the

development of children trapped by the effects of their parents' problematic drinking" (Turning

Point, 2006).

Key research should inform practice and work with children and young people affected by their

parents' misuse of alcohol.

Alcohol is no ordinary commodity. Its impact on our lives and on our families, is habitually

underplayed, and the personal, social and health risks involved are ignored or considered an

acceptable dimension of alcohol use. This undermines the change in our culture that is required if

we are to prevent the harm that blights the lives of whole families and harms the development of

children trapped by the effects of their parents' problematic drinking.

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THE POLICY GAP

Numerous policy documents and inquiries have addressed substance misuse in general, but far

less attention has been given to alcohol misuse. There is some evidence of a "siloed" response to

alcohol problems at government level that impedes policy.

Cross-government working could lead to a more co-ordinated approach to alcohol policies, in

which the needs of children affected by parental alcohol problems are more embedded within the

children's agenda.

A difficulty in the literature is that "parental substance misuse" appears as a generic category, but

a focus on parental alcohol misuse rarely exists on its own. Research suggests that assessment of

families affected by alcohol misuse needs to be comprehensive in evaluating the complexity of

alcohol misuse within the family, and its impact on family members, especially children.

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Appendix 3

SIAS Registration Form

Name …………………………………………………

D.O.B …./……/……..

Address ………………………………………………

………………………………………………………..

………………………………………………………..

Postcode ……………..

Phone number ………………………………………..

Email …………………………………………………

What is the best way for us to contact you? Post Phone Email

How did you hear about us? Facebook Twitter GP Newspaper Other

What do you hope to gain through treatment? ………………………………………………..

…………………………………………………………………………………………………

…………………………………………………………………………………………………

Would you be open to participating in focus groups? Yes No

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