Register for #LookingAfterYouToo and Book your first session

Email

Confirm Email

First Name

Family Name

Please provide a mobile phone number to allow us to send you reminder SMS messages before each session. Your coach may also use this to communicate with you in the event of problems at the time of the session, so if you don’t have a mobile, please enter a suitable phone number.

Mobile Number

In order to help us assess and encourage usage, please can you provide the following:

Your NHS Region

Your role – EXPAND the sections below and tick all that apply

Where did you hear about #LookingAfterYouToo?

Equality and Diversity

We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for.

Please provide as much information as you are comfortable with about yourself. Our privacy policy explains more about how we use and manage your data.

What is your ethnic origin?

What is your gender?

Male

Female

I do not wish to disclose

Marital Status

Age Group

What is your religion or belief (including non-belief)?

Do you consider yourself to be disabled?

Yes

No

I do not wish to disclose

What is your sexual orientation?

Evaluation Questions

To help your coach understand your current state of wellbeing and to help us measure the impact of the coaching programme, there are a number of statements below to answer. Your responses to these questions will be anonymised and aggregated when used for evaluation purposes.

Thinking About You

Please rate how often each of the following statements has applied to you over the last two weeks:

I’ve been able to make up my own mind about things

I’ve been thinking clearly

I’ve been dealing with problems well

I’ve been feeling close to other people

I’ve been feeling optimistic about the future

I look for creative ways to alter difficult situations

Regardless of what happens to me, I believe I can control my reaction to it

I believe I can grow in positive ways by dealing with difficult situations

I actively look for ways to replace the losses I encounter in life

Please indicate to what degree you agree with the following statements in relation to the last two weeks:

Is your work emotionally exhausting?

Do you feel burnt out because of your work?

Does your work frustrate you?

Please indicate how often the following statements have applied to you in the last two weeks:

Thinking About Your Job

The following questions are asking about your plans for the future. When answering these questions please think about how you generally feel about your intent to leave your current role:

I often think about leaving this organisation

I will probably look for a job at a new organisation in the next 12 months

As soon as I can find another job, I will leave this organisation

Is there anything else that you wish to share with your coach:

In order to work with us you need to give us permission to hold your data. Please see our detailed privacy policy for more details of how we use and manage your data. We will only share data with the organisations directly involved in delivering this programme.

I accept

Our team will be accessing your personal information anonymously and in an aggregated form to evaluate the impact of this programme. Please confirm you are willing to accept this.