Hertfordshire and Mid Essex Talking Therapies Webinar Registration Form

Please note to access our webinar programme you must be aged 16+ and registered, or be intending to register with a GP, in Hertfordshire or Mid Essex.

The information you provide on this form will be used to record your attendance for this NHS Hertfordshire and Mid Essex Talking Therapies webinar and to help us register you if you decide you would like further support from our service.

Your information will be stored confidentially on our secure database in the UK. No paper copy will be kept. Data may be used in anonymised format to demonstrate that we are working with the local community, which, in turn, enables us to continue providing free virtual workshops. For more details please refer to our ‘Fair Processing Notice’ and sharing information page.

If you have any concerns about how the Trust is handling your data please contact our data protection officer: hpft.dpo@nhs.net

If you have any enquiries about the webinar programme or the registration process, please contact our webinar admin team: hpft.talkingtherapieswebinars@nhs.net

More information on your rights is available from the Information Commissioners Office: www.ico.org.uk

Questions	Not at all	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things.	Not at all	Several days	More than half the days	Nearly every day
2. Feeling down, depressed, or hopeless.	Not at all	Several days	More than half the days	Nearly every day
3. Trouble falling or staying asleep, or sleeping too much.	Not at all	Several days	More than half the days	Nearly every day
4. Feeling tired or having little energy.	Not at all	Several days	More than half the days	Nearly every day
4. Poor appetite or overeating	Not at all	Several days	More than half the days	Nearly every day
5. Feeling bad about yourself — or that you are a failure or have let yourself or your family down.	Not at all	Several days	More than half the days	Nearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television.	Not at all	Several days	More than half the days	Nearly every day
8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you ha	Not at all	Several days	More than half the days	Nearly every day
9. * Thoughts that you would be better off dead or of hurting yourself in some way	Not at all	Several days	More than half the days	Nearly every day

Questions	Not at all	Several days	More than half the days	Nearly every day
1. Feeling nervous, anxious or on edge.	Not at all	Several days	More than half the days	Nearly every day
2. Not being able to stop or control worrying.	Not at all	Several days	More than half the days	Nearly every day
3. Worrying too much about different things.	Not at all	Several days	More than half the days	Nearly every day
4. Trouble relaxing.	Not at all	Several days	More than half the days	Nearly every day
5. Being so restless that it is hard to sit still.	Not at all	Several days	More than half the days	Nearly every day
6. Becoming easily annoyed or irritable	Not at all	Several days	More than half the days	Nearly every day
7. Feeling afraid as if something awful might happen.	Not at all	Several days	More than half the days	Nearly every day

Hertfordshire and Mid Essex Talking Therapies Webinar Registration Form

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