Category - Select -StudentStaff Personal information Name Surname Student number E-mail address Gender Gender - Select -FemaleMalePrefer not to sayOther… Enter other… Race Race - Select -AfricanAsianColouredIndianWhiteOther… Enter other… Faculty/ Department Faculty/ Department - Select -Economic and Management SciencesEducationEngineeringHealth SciencesHumanitiesLawNatural and Agricultural SciencesTheologyDistance LearningSupport staffOther… Enter other… Year Year - Select -1st2nd3rd4th5th and aboveHonoursMastersDoctoralOther… Enter other… Residence Residence - Select -privateOther… Enter other… Select the best option Select the best option - None -Counselling/therapyHIV testing and counsellingOffice of the social workerMentoring/coachingOther… Enter other… I take note that, within the parameters of confidentiality, the information provided will only be used for statistical purposes; That all mental health care services: are accessed voluntarily and subject to the informed consent of the health user; are considered confidential and private. Health care information will be dealt with in accordance with health care legislation and applicable ethical principles; are reliant on the active participation of the health care user, including shared decision-making; are to take place in a mutually safe and respectful environment for both the health care user and mental health care practitioners. The right of admission is reserved. Next Leave this field blank
