• connect
  • support
  • thrive

Wellbeing Coach – Self Referral

You can use this form to refer yourself to a Wellbeing Coach at Southern Brooks. (If you are a professional and would like to make a referral for your client instead, please use this form.)

This service is about helping people to make small changes to improve their wellbeing. We can do this by offering a 30-minute phone call with one of our Wellbeing Coaches, who will make a wellbeing plan with you about small steps you can take and give you information about other services in your area that might be helpful. You will also receive a few check-in phone calls after this session, to help motivate you with your wellbeing plan. We are a light-touch, short-term service, and are not specialists in serious mental health conditions. 

Having a feeling of wellbeing means:

  • to have good mental health
  • being satisfied with your life
  • feeling that you have meaning or purpose
  • being able to manage stress well

If you would like to find out more about our service, you can see our Frequently Asked Questions here

Eligibility criteria:

  • Over 18
  • Would like to make a wellbeing plan, and feel ready to make small changes to your lifestyle in order to improve your wellbeing
  • Either:
    • a resident of South Gloucestershire
    • registered at a South Gloucestershire GP surgery
    • a Bristol carer for someone living in South Gloucestershire

If you have any questions about the service, or need to refer yourself in another way, please email or call (01454) 868583.


Referral Form

Wellbeing Coach Self Referral

Your Details

I give permission to be contacted by...
Do you feel ready and able to make positive changes to support your wellbeing?

Equalities Questions

How do you describe your gender? *
Do you consider yourself to be transgender or as having a transgender history?
What is your sexual orientation?
Do you have a religion?
What is your ethnicity?
Do you see yourself as disabled?
Are you a carer?
Are you currently or have you previously served in the UK Armed Forces?
Which of the following describes your highest level of qualification?
Do you have any dependents living in your household in the following age groups?
Which of the following forms of financial support do you currently receive or are in the process of applying for?
What is your employment status?