A short form to get started

Five minutes, give or take. You can stop at any point and the answers stay on this device until you submit. Your card isn't charged unless a therapist signs your letter.

Before anything else

How are you doing right now? There's no wrong answer.

How you're feeling today

I'm okay enough to do an intake call.Things are hard, but I'm steady enough to talk for 20 minutes.Today is hard, but I'm okay to keep going.I'm struggling but not in crisis right now.I'm in crisis right now.I need to talk to someone now. We'll send you to support that can help immediately.

About you

University

Course

Year of study

I am 18 or over.

The assessment

What kind of assessment?

For example: an exam, a coursework deadline, a dissertation, a viva.

When is the deadline?

What's been happening

In a sentence or two, what's been going on?

There's no right way to write this. Plain words are fine. The therapist will go into more depth on the call.

Have you spoken to anyone about this already?(optional)

A GP, counsellor, university wellbeing service, therapist — anything you'd like the reviewing therapist to know.

Staying in touch

Email(optional)

We'll send your case ID and updates here. If you'd rather use just a case ID, leave this blank.

Consent

We split consent into the specific things we'll do, so you can see exactly what you're agreeing to. You can withdraw any of these later by emailing us.

I've read and agree to the terms and privacy notes.

I consent to the intake conversation being recorded and stored, encrypted.We use it to produce the summary the therapist works from. It's deleted on a schedule we'll publish.

I'd like the letter sent to my university EC office on my behalf.If you'd rather receive the letter and forward it yourself, untick this. You can also change your mind later.