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Assessment
Initial assessment
- Select title -
Mx
Mr
Mrs
Miss
Ms
Dr
Prof
Captain
Rev
- Select country -
United Kingdom
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Date of birth
Emergency contact/next of kin (full name, relationship, telephone number, address)
Pronouns
(optional)
They/Them
She/her
He/him
She/they
He/they
She/He/They
Other
Preferred name
(optional)
Discord contact
(optional)
Names of organisations member gives consent to share/speak with
(optional)
GP details
(optional)
Social spaces interested in attending
(optional)
Online
Basingstoke
Bournemouth
Fareham
Isle of Wight
Southampton
Portsmouth
Other
Types of support interested in attending
(optional)
Counselling/therapy (student or qualified)
Counselling/therapy (qualified only - incurs extra fee on top of membership)
Therapeutic group
1-1 social and practical support
Long term support group (6month or 12 month)
Ad hoc and one off support group(s)
Social spaces
Type of member
- Select -
Trans+
Gender questioning
Significant other to someone trans+
Supporter of trans+ people
have you used our services in the past
- Select -
yes
no
how did you hear about us?
- Select -
social media
word of mouth
gp/other healthcare provider
internet search
which of the following are supportive of you?
family
friends
partner(s)
other
none of the above
has your mental health been impacted by your/their transition?
- Select -
yes
no
has your employment status been impacted by your/their transition?
- Select -
yes
no
has your housing status been impacted by your/their transition?
- Select -
yes
no
have any of your relationships been impacted by your/their transition?
- Select -
yes
no
mental health - please tick all that apply
I have self harmed in the last six months (not including any attempt to end my own life)
I have self harmed in the past (not including any attempt to end my own life)
my self harm is/has been significant and required treatment/put my life at risk
I have attempted to end my own life
I think about suicide, but do not have any plans to act upon this
I think about suicide, and have plans/worry that I may act on this
I have been diagnosed with a mental health condition (please give details below)
I take medication for my mental health
I have taken medication for my mental health in the past
I have anxiety
I have depression
I have substance dependency/misuse issues
I have, or historically have had, issues around food/disordered eating
I have/have historically had a diagnosed eating disorder
I have issues with body image/dysmorphia/dysphoria
I feel isolated
none of the above
do you have any of the following?
autism - professionally diagnosed
autism - suspected or self diagnosed
ADHD - professionally diagnosed
ADHD - suspected or self diagnosed
other neurodivergence - professionally diagnosed
other neurodivergence - suspected or self diagnosed
learning difficulties/disability - professionally diagnosed
learning difficulties/disability - suspected or self diagnosed
physical disability
none of the above
are there any triggers that we need to be aware of for you?
(optional)
do you have any medical/health/mental health conditions that we should be aware of? (please give details)
(optional)
do you have any support or access needs that we might need to be aware of? (please give details)
(optional)
have you experienced any hate crime?
- Select -
yes, and I would like support with this
yes, but I do not need any support with this
no
do you have any criminal convictions
- Select -
no
yes, but I have no probation officer
yes, and I have a probation officer
Beyond Reflections is a low-cost support service. Most members pay towards support received.
- Select -
I understand that I will have to pay for services
I need to talk to you about this
the next step of the onboarding process will be a video call. It will include showing photo identification, and discussing gender identity, and goals.
I understand
Declarations
I have read and accept the privacy policy
Privacy policy
I have read and accept the counselling agreement
Counselling agreement
I have read and accept the in-person group agreement
In-person group agreement
I have read and accept the in-person social spaces agreement
In person social spaces agreement
I have read and accept the membership agreement
Membership agreement
I have read and accept the 1-1 support agreement
1-1 support agreement
I have read and accept the online group agreement
Group agreement
I have read and accept the online social spaces agreement
Online social spaces agreement
I am an adult (18+ years old)
I understand that I cannot opt out of important updates by email.
If you are a human, ignore this field
Join now
Privacy policy
Beyond Reflections is registered in England and Wales under charity number 1187351.
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