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Enrolment form – Cancer patients

We look forward to booking you onto our next course. Please note that all information will be held in accordance with our GDPR policy.

The Active Breathing Course (ABC) is a free, six-week program funded by the National Lottery Community Fund and approved by the NHS. This course is specifically designed to assist individuals in recovering from the impact of cancer, with a focus on improving symptoms of breathlessness and providing support for anxiety.

We look forward to booking you onto our next course. Please note that all information will be held in accordance with our Privacy policy.

Your Details
Delivery
Please enter delivery details for your resource pack for online courses. (Please note that for in-person courses the resource pack will be provided at the course location during your first session, so please leave this section blank)
Pre-course assessment form
The following questions are about any symptoms you experience. These are helpful for your course tutor to understand so they can best support you in course sessions.
ABC has been found to help people who struggle with depression and/or anxiety. To help us continue to measure its impact, please answer the following impact questions measuring generalised anxiety disorder and depression symptoms. This information will not be passed on to course tutors and will be held in the strictest confidence in accordance with our Privacy Policy.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Your Privacy

We will always store your personal details securely. We'll use them to provide the service that you have requested, and communicate with you in the way(s) that you have agreed to. Your data may also be used for analysis purposes, to help us provide the best service possible. For full details see our Privacy Policy

K Reekie
Karen Reekie

Independant Advocate – Women’s Services 

Karen is our independent advocate who works supporting women who need help with accessing services or rights they are entitled to, and admin needs. She works at Kingston and also at our Elmbridge Women’s hub.

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