Manage Your Mind Web Application
Date Of Birth
Address Line 1
Address Line 2
Do you have a disability we need to be aware of to accommodate you on the course?
Past Medical History
How did you hear about the course?
Word Of Mouth?
Counsellor Or Other Health Professional? If so, who?
Internet Or Social Media?
Flyer? If so, where?
Poster? If so, where?
Other (Please Specify)?
Our website should give you all the information you need about the Manage Your Mind workshop, however, if you would still like to talk to a member of our team, please tick this box
By ticking this box you confirm that you are over the age of 16yrs, are not pregnant, are not addicted to drugs or alcohol, are not psychotic or suicidal and are currently not on any tranquilising or antipsychotic drugs. By clicking submit you agree to our