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Thank you for your interest in South East London Mind (SEL Mind)'s LGBTQIA+ peer support group: Queer Minds. The group meets fortnightly on Tuesdays 6:30-8:30pm. Visit our website (selmind.org.uk/queermindsls) for more details.

If you would like to register your interest to attend any of our Queer Minds sessions, please complete this form.

Please note that all fields with a red * are compulsory and must be completed before you can submit this form.

Identity

Forename

Surname

Date of birth

Address

Address 1

Address 2

Town

Post Code

Where do you live?

Contact

Mobile

Emergency contact details: Please include full name, relationship to you, phone number(s) and email address

Additional Information

Please share with us why you would like to join our Queer Minds peer support group. Feel free to share as much or as little as you would like. Please also let us know if you have any accessibility needs for the session

Referral Information

Referral Source

How did you hear about us?

Queer Minds

Client Registration Form

Identity

Address

Contact

Additional Information

Referral Information