Relationship breakdown - a survey to help us understand how to develop a group that meets your needs

* 1. How long ago did you experience a relationship breakdown?

* 2. Since your breakup how supported did you feel when you wanted or needed help from others?

* 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?

* 4. Please indicate how many of the themes below would be helpful to you from a structured programme?

* 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?

* 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

* 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?

* 8. Please tell us how old are you?

* 9. If you would like us to contact you with more information regarding this support programme please indicate your consent below 

* 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