Welcome to Horsham WISH.

Completing this survey will allow WISH to offer you suitable services, support and information that is most relevant to you and your needs. 

Once completed we will be in touch with you shortly. 

If you need additional support to complete this please call 07783 222956.

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* 1. What is your name?

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* 2. What is the best telephone number to contact you on?

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* 3. What is your email address?

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* 4. Where do you live? (just village or town, not address)

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* 5. What benefit are you on?

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* 6. Your current situation.

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* 7. Do you have a disability / health condition? (will be discussed at first appointment)

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* 8. Do you have a criminal record?

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* 9. What kind of work are you looking for? (tick all relevant)

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* 10. What assistance would you like to receive? (tick all relevant)

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