Assessment

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Initial assessment

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 (if any, and if you wish BR to work with other organisations supporting you) (optional)

GP details (optional)

Social spaces interested in attending (optional)

Online

Basingstoke

Bournemouth

Fareham

Isle of Wight

Southampton

Portsmouth

Other

Type of member

Please select 'completed' - this will not impact your form, but it will mean that the automatic system will not prompt you to fill the form in again.

Completed

have you used our services in the past

how did you hear about us?

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?

has your employment status been impacted by your/their transition?

has your housing status been impacted by your/their transition?

have any of your relationships been impacted by your/their transition?

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?

do you have any criminal convictions

Beyond Reflections is a low-cost support service. Most members pay towards support received.

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

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.

I confirm that the above information is true to the best of my knowledge

If you are a human, ignore this field

Beyond Reflections is registered in England and Wales under charity number 1187351.