Peer Pod enquiry form

Title *MrMrsMissMsMxProfDrRevOther

Name *

First

Last

Email *

Phone

Which of our Peer Pod sessions are you interested in attending?

• Parents with MS
• MS and Work
• Newly Diagnosed
• Sunday Drop-in
• Monday drop-in
• Tuesday drop-in
• Wednesday drop-in
• Creative Writing
• Caregiver's
• Women's
• LGBTQ+

Which of the Women's sessions would you like to attend?

• Thursday 6:45pm
• Friday 11am
• Both

Which of the Men's sessions would you like to attend?

• Monday 2pm
• Thursday 7pm
• Both

Have you attended a peer support group before? (in relation to MS or not)?

• Yes
• No

What are you looking to gain out of our Peer Pod sessions?

• Meet new people who understand what I'm going through whilst supporting each other
• A place to share my experiences/feelings about MS and other matters in my life
• Gain encouragement from others
• Other

What is not listed that you would like to gain from our sessions?

Where did you hear about us?MS-UK websiteHealth professional/MS nurseSocial mediaMS-UK HelplineEmail / e-newsAnother MS charityNew Pathways magazineMS-UK's online activitiesPeer PodsOnline training

Please let us know if you have any comments, or suggestions for a Peer Pod

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