Referral Form: Student Support Group

Referral Form: Student Support Group

This form is for students aged 16+ to refer themselves into our weekly psychoeducation group which runs every Tuesday at 6pm over Microsoft Teams.
If you are a parent, carer, or loved one of someone with disordered eating or body image issues, we offer a range of support for you. Please complete one of the below forms instead, by copying and pasting the URL into a new browser:

If you are over 18 and want to know more about our parent/carer support, you can refer yourself to us here:

https://form.jotform.com/200025235042032

If you are over 18 and are wanting to register for our "Skills for Carers" 4-week psychoeducational programme, please complete this registration form:

https://form.jotform.com/220964041104343
Benefits to expect from our Workshops

Recovery Self-help groups are proven to help service users develop support networks, improve communication skills, and practice putting themselves outside of their own struggles and behaviours. In most group settings, service users explore different topics in depth and participate in activities, and are focused on providing education through evidenced-based information sharing and the development of healthy coping mechanisms.
Do you have a clinical diagnosis?

Recovery Self-help groups at First Steps ED are a secure and safe place for peer groups to come together and unfortunately if you are currently diagnosed or waiting a diagnosis for a Severe or Enduring Eating Disorder (SEED) with the NHS our weekly Recovery Self-help groups will not provide you with the care and support you need right now. If you feel that you can benefit from any one of our weekly groups but your eating disorder is severe or enduring, we ask you to first make a referral on our website to attend an initial assessment. https://firststepsed.co.uk/make-a-referral
Which workshop are you registering for?

Parent/Carer Support (adults only)Student (EDISS) Support Group (adults only)Body Image WorkshopKundalini Yoga - £5 attendance fee (aged 15+)Binge Eating Disorder Workshop (aged 15+)Young People's Wellness WorkshopARFID Workshop (for sensory eating difficulties)"Create Steps" creativity group (adults only)
Contact Information
Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Phone Number

Area CodePhone Number
Which university/college do you attend? *
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
How did you hear about the workshop?*

Social MediaInternet search engineWord of mouthFirst Steps ED websiteFirst Steps ED NewsletterProfessional ReferralStudent Space (University Students)Other
Date of Birth*

DayMonthYear
Date
In Case of Emergency
GP practice name*
Only to be used in case of an emergency
Name of emergency contact (Next of Kin)*

First NameLast Name
Phone Number of emergency contact

Area CodePhone Number
Phone Number of Emergency Contact*
Equality and Diversity Monitoring
What is your gender?*

FemaleMaleNon-binaryTransgenderPrefer not to sayOther
What is your religion/religious denomination?

ChristianityIslamSikhismJudaismHinduismBuddhismJanismTaoismNo religionPrefer not to sayOther
What is your sexual orientation?

Straight/HeterosexualBisexualGay/HomosexualPrefer not to sayOther
What is your nationality/ethnic origin?

ArabAsian / Asian British- IndianAsian / Asian British- PakistaniAsian / Asian British- BangladeshiAsian / Asian British- ChineseAsian / Asian British- Any other Asian backgroundBlack / African / Caribbean / Black British- AfricanBlack / African / Caribbean / Black British- CaribbeanBlack / African / Caribbean / Black British- Any other Black / African / Caribbean backgroundMixed / Multiple ethnic groups- White and Black CaribbeanMixed / Multiple ethnic groups- White and Black AfricanMixed / Multiple ethnic groups- White and AsianMixed / Multiple ethnic groups- Any other Mixed / Multiple ethnic backgroundWhite- English / Welsh / Scottish / Northern Irish / BritishWhite- IrishWhite- Gypsy or Irish TravellerWhite- Any other White backgroundAny other ethnic groupsPrefer not to sayUnsureOther
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Referral Form: Student Support Group

Benefits to expect from our Workshops

Do you have a clinical diagnosis?

Contact Information

In Case of Emergency

Equality and Diversity Monitoring