Contact | A Safe Space to be Me

Support Request

Please fill out the following form.

All information will be treated as confidential.

First name

Last name

Date of birth

Day

Month

Year

Telephone

Email

Address

Which Service is your enquiry about?

Who is this enquiry about?

Have they consented to the referral?

For 3rd party referrals please provide us with the contact details of the person this enquiry relates to -

If this enquiry is relating to someone under 18 please tell us their date of birth

Day

Month

Year

Enquires relating to Neurodiversity

Can you tell us more about this? (ND)

Im Enquiring about workshops for service users with ADHD & other neurotypes

Tell us which workshops you are enquiring about?

Can you tell us more about this? (MH)

Please tell us as much information as possible to help us with your enquiry.

College or Training Institution Attending

Which course are you currently completing?

When do you anticipate starting client work? Month/Year

I confirm i am aware that if i am offered a placement with ASSTBM that i am required to volunteer as part of a organisation familiarisation

If enquiring about a student placement, please attach an up to date CV

What type of training are you interested in?

ADHD & Neurodiversity Awareness

Trauma-Informed Practice

Workplace Wellbeing & Inclusion

Bespoke Training Package

Not sure yet – I’d like to discuss options

Feel free to tell us a bit more about your needs -

Check here and we will get in touch.

I consent to being contacted via email, text message and/ or telephone.