SocialEyes course registration form

    To register an interest in taking part in the online SocialEyes course for autistic adults aged 19 to 25, please complete this form – our support workers will contact you. Please note that to attend this course, you must have a diagnosis of autism or be on the waiting list for an autism assessment, and be registered with a GP surgery that is part of the Berkshire West NHS Clinical Commissioning Group, which serves the Reading, Wokingham and West Berkshire council areas.

    First Name

    Surname

    Telephone number

    Email address

    Your address

    Postcode:

     

    Which GP surgery are you registered with?

     

    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.