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This private form is for any young person in Newport aged 11-17 years who wants to chat to a counsellor online.

(dd/mm/yyyy)

6.6. If your parents contact us or your school, can we inform them that you are receiving counselling? (we will only do this if necessary) Required
7.7. Are you happy for your Head of Year to know that you are receiving counselling? Required

This part of the survey uses a table of questions, 

13.13. The following questions are about how you have been feeling OVER THE LAST WEEK. Please read each question carefully. Think how often you have felt like that in the last week and then tick the box you think fits best. Copyright CORE System Trust - Supported by www.coreims.co.uk Required
Not at allOnly OccasionallySometimesOftenMost or All of the Time
I've felt edgy or nervous
I haven’t felt like talking to anyone
I’ve felt able to cope when things go wrong
I’ve thought of hurting myself
There’s been someone I felt able to ask for help
My thoughts and feelings concern me
My problems have felt too much for me
It’s been hard to go to sleep or stay asleep
I’ve felt unhappy
I’ve done all the things I wanted to