Name of service

Key contact

Telephone number

Fax number

Address

Email address

Website address

When is your service available? (e.g. working hours)

What does your service offer? Please describe in detail.

What are the aims of your service?

Do you work nationally or only in a certain geographical area? (tick all that apply)

What type of service do you offer? (tick all that apply)

What form does this take? (tick all that apply)

What type of organisation is your service? (tick all that apply)

When was your service founded? (YYYY-MM-DD)

If you have a waiting list, please select the duration

Please describe the people you serve (e.g. do you see young people, parents, families) and the clients you are most likely to see.

Are there clients you do not yet reach that you would like to attract?

Young people seen per week

Parents seen per week

Families seen per week

Minimum age

Maximum age

Please describe how people come to your group. Are they:

Does your service work closely with any other organisations or services? If so which? (write in)

Does your service do anything from which you think other services could learn? If so, please describe.

Would you like the opportunity to share ideas, methods, concerns and new ways of working with other services? If so please indicate any areas of practice that you would like to see discussed on the site (write in)

If you would like to receive updates from our website, please select a frequency

Is there any feature which you feel you would like to see included on the website? (write in)