Living Well Consortium - Healing Circles - Register your Interest Form

1. Register Your Interest in our sessions

Living Well Consortium have been awarded funding from The National Lottery to provide access to Healing Circle sessions in partnership with Pattigift Therapy and Our Roots CiC. To register your interest for taking part in the sessions please complete this form and we will be in touch to direct you to accessing sessions. The information we are asking for is for monitoring purposes only.

The information that we collect will only be shared within our Consortium and The Funder (The National Lottery) for evaluation and monitoring purposes only.

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* 1. Please confirm which organisation's sessions you are interested in attending?

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* 2. Your Initials

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* 3. Contact Number - so that we can call you to arrange the sessions

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* 4. Contact Email Address - so that we can confirm the virtual meeting link with you

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* 5. Gender

Female

Male

Binary

Non-binary

Prefer not to say

If you would prefer to self identify please provide the details below:-

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* 6. Which sessions are you interested in attending?

Circles for Older Women

Circles for Older Men

Circles for Younger Men

Circles for Younger Women

Circles for professionals/key workers

Generic Circles

Circles for Men (18+)

Please provide some details about the sort of thing you want to discuss at the sessions