Your name

Please choose the options that fits best:

I feel anxious about my ED.

—Please choose an option—Not at allA littleQuite a bitA lot

I feel confident about managing my ED.

—Please choose an option—Not at allA littleQuite a bitA lot

I feel isolated.

—Please choose an option—Not at allA littleQuite a bitA lot

I feel my stress levels increasing.

—Please choose an option—Not at allA littleQuite a bitA lot

I have someone to confide in.

—Please choose an option—Not at allA littleQuite a bitA lot

I find it easy to talk about my ED.

—Please choose an option—Not at allA littleQuite a bitA lot

My physical wellbeing is good.

—Please choose an option—Not at allA littleQuite a bitA lot

I feel supported in managing my ED.

—Please choose an option—Not at allA littleQuite a bitA lot

I would like to meet others with ED.

—Please choose an option—Not at allA littleQuite a bitA lot

I have knowledge of EDs.

—Please choose an option—Not at allA littleQuite a bitA lot

Consent given by:

Your data

SupportED takes your privacy seriously and this includes care for your personal information. We have a Privacy Policy which is GDPR compliant. This is available on our website.

Please tick this box to confirm you are aware of how you can access our Privacy Policy.

I confirm I am aware of how I can access your Privacy Policy.

Communication

Our preferred means of communication is by email and we may occasionally contact you by phone. Please let us know if you prefer other means of contact. Your Befriender will always call you by phone from a withheld number. In line with our Privacy Policy you can ask to be removed from our mailing list or or contact databases at any time.

Please tick this box to indicate that you have read and agree with the above:

I have read and agree with the above.

Complaints

Please tick this box to confirm you are aware you should contact our Operations Director on hello@supportedscotland.org should you wish to complain about the service provided by SupportED.

I am aware of how to make a complaint.

Membership

We want your say on how we develop our services and organisation. As such you are invited to join our free membership. As a member you will receive our Annual Report and Accounts, be entitled to vote at the Annual General Meeting (AGM) and to stand for election on our Management Committee. You will receive notice of the AGM. From time to time you will also receive news of what is happening within the charity or to inform you of events.

Please tick this box if you wish to be part of our membership and being included on our mailing list.

I wish to be part of your membership and being included on your mailing list.

Your privacy

To ensure our service is safe and meets your needs we may need to share information with your befriender, any person who has power of attorney for you, any person nominated as your emergency contact or any other professionals involved with you.

If you agree to this, please tick this box.

I agree to this.

Phone number

Please write the phone number you would like us to share with the befriending volunteer:

Email address

Please write the email address you would like us to share with the befriending volunteer (they will only contact you from their name@supportedscotland.org account):

Your emergency contact details

Relationship to you (e.g. friend, colleague, sister, health professional etc.):

Your address

Please write the address where you are most likely to be taking the befriending calls (including postcode) in case of emergency:

Access

Do you have an access considerations that we need to be aware of?

A bit about you

This is an opportunity to say a bit about yourself that will be given to your befriender before their first call. It can be about your eating disorder, your hobbies, or something else entirely. Our befriending volunteers really appreciate what you have to say and we encourage you to put a few details in here to make your first conversation the best it can be:

How did you hear about SupportED?

I have read and consent to the Privacy Policy.