Moving on..... Relationship breakdown - a survey to help us understand how to develop a group that meets your needs Question Title * 1. How long ago did you experience a relationship breakdown? Less than 6 months ago 6 months to a year ago One year to five years ago Over five years ago OK Question Title * 2. Since your breakup how supported did you feel when you wanted or needed help from others? Well supported and still supported now by family, friends, work colleagues Well supported at the start by everyone but it's dropping off now Don't like to burden family and friends with how I feel about it Find it very difficult to talk to anyone about what had happened OK Question Title * 3. HCCG are hoping to develop a structured support group to help you think about relationship breakup and how to move on. This group is likely to meet weekly in an evening. Would you consider attending? Yes No Not sure would like more detailed information first OK Question Title * 4. Please indicate how many of the themes below would be helpful to you from a structured programme? Why we want relationships and who we are attracted to Learning about how to avoid repeating problems Letting go of the old relationship Understanding myself and family patterns of relationship Sex and intimacy Creating a new life Understanding and managing conflict OK Question Title * 5. The programme will run for 8 sessions and is likely to cost approximately £24 per session (total amount payable in advance). Thinking about this cost do you feel this is reasonable for an eight week facilitated group? Yes this is reasonable No this is more than I could afford OK Question Title * 6. If you are not interested in a group format are there any other formats that might appeal to you, for example, a one day workshop? Please give your suggestions below OK Question Title * 7. Do you feel an information event where you could come along and meet with us to learn more about the programme encourage you to attend? Yes No Possibly OK Question Title * 8. Please tell us how old are you? 18-24 25-34 35-44 45-54 55-64 65+ OK Question Title * 9. If you would like us to contact you with more information regarding this support programme please indicate your consent below Yes No OK Question Title * 10. If you answered 'Yes' to Q.11 please supply your name and an email address where we can reach you below. Your name and email will be kept confidential and will not be shared or used except for the purpose of contacting you regarding this support group Name Email Address OK DONE