Chop & Chat course registration form

    To register an interest in taking part in the online Chop & Chat course for autistic adults, please complete this form – our support workers will contact you. Please note that you must have a diagnosis of autism, or be on the NHS waiting list for an autism assessment, be aged 18 or above and be registered as a patient at a GP surgery in Berkshire to attend this course

    First Name

    Surname

    Telephone number

    Email address

    Your address

    Postcode:

     

    Which council area do you live in?

    If you answered Other above, please give the council name

     

    Privacy and data protection

    Personal information you submit using this form will be treated as confidential. See our privacy policy for more information.