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Register to attend Container of Hope at BaMH SC

Questions marked with a * are required

Please fill out your details below to register for our weekly mental health peer support group. This will allow us to make space for everyone, ensuring a comfortable and informative experience for all participants.

Which group date are you registering for?
Groups are held weekly from 1 pm to 2:15pm each Wednesday. Sessions run for 1.25 hours and are initially held on site at Brain & Mind Hub Sunshine Coast. Please select the date you plan to attend your first session, and our friendly Administration team will be in touch to confirm your attendance.

Wednesday 2 October 2024

Wednesday 9 October 2024

Wednesday 16 October 2024

Wednesday 23 October 2024

I would like to start at a later date. Please get in touch with more details.

Your details
We will only use this information to contact you about the Container of Hope group at Brain & Mind Hub Sunshine Coast. There is an option to opt-in for information about other programs further down.

First name

Last name

Phone

Email address

Preferred name:

Accessibility requirements:

I use a wheelchair

I have a physical disability or limitation

I am deaf or hearing impaired

I am blind or visully impaired

I have environmental sensitivities such as auditory sensitivities

There is something else that BaMH can assist with:

Something else:

Mental health history

Have you previously seen a therapist or psychiatrist?

Have you ever been diagnosed with a mental health condition?

Are you currently receiving support or treatment at Brain & Mind Hub Sunshine Coast?

If you answered 'yes' to having been diagnosed in the past, please specify the condition(s):
This will help us to understand what information, strategies and support will be most helpful, and will be kept confidential.

Next of kin or preferred support person:

First name

Last name

Phone

Email address

Relationship to person

How we treat your personal information:
We request your consent to store your personal information securely as part of providing mental health services. This information includes your name, contact details, medical history, and treatment records. It will be used exclusively to enhance your care and ensure the highest quality of service. Your information will be kept confidential and will only be shared with authorised personnel directly involved in your treatment or as required by law. By signing this form, you agree to the collection, storage, and use of your personal information as described.

FULL NAME

EMAIL

Please enter the 4 digit code sent to

Resend code / Change email

Please type your signature in the box

Neuroscience for better mental health

Keeping your personal information secure
We place the highest importance on protecting the privacy and personal information of people seeking support and treatment at Brain & Mind Hub Sunshine Coast, as well as the privacy of their support people. We have comprehensive measures in place to ensure the security of your personal information, and you can learn more by viewing our Privacy Policy at tbmh.org.au/privacy-policy.

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