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WE REALLY WANT TO TAILOR OUR SUPPORT FOR YOUR INDIVIDUAL NEEDS. YOU CAN HELP US BY TELLING US MORE ABOUT THE FOLLOWING:

    1

    How many addictions do you have and what are they?


    2

    What is the biggest addiction?


    3

    How much are you spending weekly on your addictions?

    £

    PER WEEK


    4

    Have you tried stopping any of them before?

    YesNo

    If yes, which ones and what did you do?


    5

    How long have you been addicted?


    6

    How much negative impact are these addictions having on other areas of your life?


    7

    How much negative impact are these addictions having on your relationships?


    8

    Have you been diagnosed with a mental health condition?


    9

    Why have you now decided to get help?


    10

    What do you think your life would feel/look like without the addictions?


    11

    About You



    12

    Your Contact Details




     

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