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Mind CWW provides free online text-based support to young people across Coventry, Warwickshire and Worcestershire.

To sign up please complete this form and we'll get back to you within 72 hours. We may want to talk with you a little more about your referral, so do keep an eye on your inbox.

Please note there is a wait time before we'll be able to allocate you to one of our practitioners for one to one support. Our welcome team will be able to give an idea of how long this wait will be once signed up, but it is generally between 8-12 weeks.

If you feel you need more urgent help please click here ADD LINK HERE //.

If you are having any problems completing this form, please email admin@cwmind.org.uk

First, tell us a little bit about you

To get started, please tell us your date of birth

Date of Birth

Confidentiality

It’s important to us that any information you give to us is kept private and confidential; there may also be times when we need to tell someone else (like your GP) some information you’ve told us if we think someone might be at risk of serious harm. We will always try to talk to you about this first if we can. We want you to know that decisions made to share your information are always made with safety as our priority.

We encourage you to look at our data & confidentiality policy to find out more and if you’d like to ask us about anything, you can reach us onlineteam@cwwmind.org.uk.

* I agree to the data and confidentiality policy

We also want it to be your decision to come to us, and it’s important you don’t feel pressured or forced into doing so.

* I confirm I'm filling in this form myself and want to access the services from CWW Mind Development Site

Mind CWW keeps basic statistics in order to make sure we meet the needs of the whole community. We also use anonymised data with funders and evaluators. Whether or not you consent to us doing this is entirely your choice and won't affect your support with CWW Mind in any way. We never share anything from your sessions or anything that could identify you, just anonymous demographics and trends in engagement to ensure the quality of our service.

Your data choices:

I consent for anonymous data to be used for monitoring the quality of our services with NHS and similar funding bodies

I consent for anonymous data to be used for external evaluations

Your Support

The following services are available in your area:

Webinars

Free and informal online groups, designed to provide practical help and information about key issues you might be struggling with in your life.

For more information about Webinars, click here.

Online Support

Free online support, giving you weekly one-to-one support with an allocated worker to help you through tough times.

For more information about Online Support, click here.

Which service would you like to register with? (Please note you can register for one or more services) *:

Webinars

Online Support

Accessing one to one supportâ€¦

In person

Text-based

Phone-based

Video-based

Self-guided SilverCloud

Can you tell us why you'd like support? It may help to think about what you're experiencing, how long it's been affecting you and what you'd like to be different.

If we’re especially worried about your safety from this info then we’ll message online to talk more. If we can’t reach you we’ll follow our safeguarding guidelines, which may mean trying to reach you, or others, outside of the platform. You can read more HERE. Add link here //

About You

Repeat Email

Password

Password length shouldn't be shorter than 8 characters
Password must contain at least one special character
Password must contain at least one digit
Password must contain uppercase and lowercase letters

Password Confirmation

Display Name

Please pick a display name that is not your name, email address or a username you use regularly on other sites, so that you feel able to use our online support services in confidence.

First Name

Last Name

Pronouns What are pronouns?

Search for an address or postcode

Address not found, please enter manually.

Address 1st Line

Address 2nd Line

Address Town

Address County

Address Postcode

Contact Number

In addition to messages on this site, how would you like us to communicate with you? (you must pick at least one option)

By e-mail *

By text

By phone

Leaving voicemails

Through the post

If you like, we can use TextMagic to send you a text, letting you know when you have unread messages.

Yes No

Your Doctor/GP's Postcode Search

Please make sure you provide your GP information. We will not contact your GP without your permission or without contacting you first. You can check our confidentiality policy here. Add link here //

Your Doctor/GP's Name

Your Doctor/GP's Practice

Your Doctor/GP's Address

Your Background

Your answers in this last section help us understand who our services are reaching as well as providing the opportunity for us to suggest relevant projects and additional support options you may be able to access.

Theres also a "prefer not to say" option on all of them and we only want you to provide information you're comfortable with.

How do you describe your ethnicity

How do you describe your gender?

Please describe your gender

Is your gender identity different to the one you were assigned at birth?

Do you identify as intersex?

How do you describe your sexuality

Do you feel you have a disability?

Is your disability

Are you pregnant or currently caring for a child under two years old?

How do you describe your employment status

Are you, or have you been, in care?

Not sure? Find out more about what this means here

Please select the locality where you are, or were, in care

Are you a young carer?

Not sure? Read more about what a young carer is here

If there’s anything that would support you accessing our services, please let us know here (for example, any accessibility needs, language barriers, preferences around the identity of your worker or any other specialist requirements that will make accessing support easier)

How did you hear about us?

Register new account

First, tell us a little bit about you

Great! You are eligible to sign up.

Our support is only available for ages 16-25 in Coventry, Warwickshire and Worcestershire

Confidentiality

Your data choices:

Your Support

Webinars

Online Support

Accessing one to one supportâ€¦

Safeguarding Risk Section

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Postcode Search

Your address

We need your contact details

In addition to messages on this site, how would you like us to communicate with you? (you must pick at least one option)

Please tell us about your GP

Emergency contact

Your Background

Please tell us about your background

Please tell us about any disabilities you may have

Please tell us about your work or education

Heard from?

Register new account

First, tell us a little bit about you

Great! You are eligible to sign up.

Our support is only available for ages 16-25 in Coventry, Warwickshire and Worcestershire

Confidentiality

Your data choices:

Your Support

Webinars

Online Support

Accessing one to one supportâ€¦

Safeguarding Risk Section

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Postcode Search

Your address

We need your contact details

In addition to messages on this site, how would you like us to communicate with you? (you must pick at least one option)

Please tell us about your GP

Emergency contact

Your Background

Please tell us about your background

Please tell us about any disabilities you may have

Please tell us about your work or education

Parental consent

Heard from?