Sporting Wellness Support

First Name*

Surname*

Email*

Phone Number*

Please enter the best mobile number to contact you on as we will send you a text message once your referral has been processed.

Gender*

Other Gender*

(Please specify)

Ethnicity*

Address

House Name/Number*

Postcode*

Which sport or sports, have you competed/participated in over the last two years?*

What level have you competed/participated at in your chosen sport/sports? (Please provide as much information as possible)*

Are you a member of a Professional Body? (e.g. PFA, RFU, ATP, PCA etc.)*

What mental health issues do you think you might be experiencing?*

Do you know how you think you’d like us to help?

Note – our specialists will offer expert support on the most appropriate support/treatment. If you find this question difficult to answer, please leave blank.

Are you currently attending university?*

Name of university*

Do you have a stakeholder code? (optional)

If so please enter below, otherwise leave this field blank.

Where did you hear about us?*

As part of our safeguarding policy, Sporting Wellness reserves the right to contact outside agencies if our clients disclose information that our agents consider put them at risk of harm and/or neglect.

Your data will be used in accordance with our Privacy Notice

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Fill in our self-referral form below to access our support system today!

Professional Counselling

An Online CBT Programme

24/7 Support Line & LiveChat

Wisdom AI - Instant counselling advice

24/7 Legal Support

The My Healthy Advantage App

For your guidance

Address

Every athlete deserves professional well-being support. If you need some help, we are here

If you're looking to support us in our efforts to make mental healthcare accessible in sport, please get in touch