www.penumbra.org.uk Open in urlscan Pro
5.77.50.250 Public Scan

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Submitted URL:
http://penumbra.org.uk/
Effective URL:
https://www.penumbra.org.uk/
Submission: On May 14 via api (May 14th 2024, 8:50:34 am UTC) from GB — Scanned from GB

Form analysis
4 forms found in the DOM

Name: East Ren Peer Support — POST

<form class="elementor-form" method="post" name="East Ren Peer Support"> <input type="hidden" name="post_id" value="23108"> <input type="hidden" name="form_id" value="794c0d7"> <input type="hidden" name="referer_title" value="Penumbra Mental Health">
  <input type="hidden" name="queried_id" value="246">
  <div class="elementor-form-fields-wrapper elementor-labels-above">
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c0f447b elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_5c850c5 elementor-col-50"> <label for="form-field-field_5c850c5" class="elementor-field-label"> Do you live in East Renfrewshire ? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Yes " id="form-field-field_5c850c5-0" name="form_fields[field_5c850c5]"> <label for="form-field-field_5c850c5-0">Yes </label></span><span
          class="elementor-field-option"><input type="radio" value="No" id="form-field-field_5c850c5-1" name="form_fields[field_5c850c5]"> <label for="form-field-field_5c850c5-1">No</label></span></div>
    </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_383ab61 elementor-col-50"> <label for="form-field-field_383ab61" class="elementor-field-label"> Are you aged between 18 and 65 years?
      </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Yes " id="form-field-field_383ab61-0" name="form_fields[field_383ab61]"> <label for="form-field-field_383ab61-0">Yes </label></span><span
          class="elementor-field-option"><input type="radio" value="No" id="form-field-field_383ab61-1" name="form_fields[field_383ab61]"> <label for="form-field-field_383ab61-1">No</label></span></div>
    </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_eaabfff elementor-col-50"> <label for="form-field-field_eaabfff" class="elementor-field-label"> Do you currently use a mental health service
        in East Renfrewshire? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Yes " id="form-field-field_eaabfff-0" name="form_fields[field_eaabfff]"> <label for="form-field-field_eaabfff-0">Yes </label></span><span
          class="elementor-field-option"><input type="radio" value="No" id="form-field-field_eaabfff-1" name="form_fields[field_eaabfff]"> <label for="form-field-field_eaabfff-1">No</label></span></div>
    </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_18b41ee elementor-col-50"> <label for="form-field-field_18b41ee" class="elementor-field-label"> If yes, which service(s) do you use? </label>
      <input size="1" type="text" name="form_fields[field_18b41ee]" id="form-field-field_18b41ee" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c3eb6e4 elementor-col-50"> <label for="form-field-field_c3eb6e4" class="elementor-field-label"> How did you hear about East Ren Peer service?
      </label> <input size="1" type="text" name="form_fields[field_c3eb6e4]" id="form-field-field_c3eb6e4" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_992ad6a elementor-col-50"> <label for="form-field-field_992ad6a" class="elementor-field-label"> Have you use the East Ren Peer service
        before? </label> <input size="1" type="text" name="form_fields[field_992ad6a]" id="form-field-field_992ad6a" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_37191ad elementor-col-100"> <label for="form-field-field_37191ad" class="elementor-field-label"> If yes, please tell us when you used the
        East Ren Peer service: </label> <input size="1" type="text" name="form_fields[field_37191ad]" id="form-field-field_37191ad" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_79932cd elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0dbccbb elementor-col-50"> <label for="form-field-field_0dbccbb" class="elementor-field-label"> First </label> <input size="1" type="text"
        name="form_fields[field_0dbccbb]" id="form-field-field_0dbccbb" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f359e08 elementor-col-50"> <label for="form-field-field_f359e08" class="elementor-field-label"> Surname </label> <input size="1" type="text"
        name="form_fields[field_f359e08]" id="form-field-field_f359e08" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_50dcc97 elementor-col-50"> <label for="form-field-field_50dcc97" class="elementor-field-label"> Address </label> <textarea
        class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_50dcc97]" id="form-field-field_50dcc97" rows="2"></textarea> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a287dc2 elementor-col-50"> <label for="form-field-field_a287dc2" class="elementor-field-label"> Postcode </label> <input size="1" type="text"
        name="form_fields[field_a287dc2]" id="form-field-field_a287dc2" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_7cda6d8 elementor-col-50"> <label for="form-field-field_7cda6d8" class="elementor-field-label"> Date of Birth </label> <input type="date"
        name="form_fields[field_7cda6d8]" id="form-field-field_7cda6d8" class="elementor-field elementor-size-xl  elementor-field-textual elementor-date-field elementor-use-native" pattern="[0-9]{4}-[0-9]{2}-[0-9]{2}"> </div>
    <div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50"> <label for="form-field-email" class="elementor-field-label"> Email </label> <input size="1" type="email"
        name="form_fields[email]" id="form-field-email" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_51a3c08 elementor-col-100"> <label for="form-field-field_51a3c08" class="elementor-field-label"> Phone number </label> <input size="1"
        type="tel" name="form_fields[field_51a3c08]" id="form-field-field_51a3c08" class="elementor-field elementor-size-xl  elementor-field-textual" pattern="[0-9()#&amp;+*-=.]+"
        title="Only numbers and phone characters (#, -, *, etc) are accepted."> </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3eb5121 elementor-col-50"> <label for="form-field-field_3eb5121" class="elementor-field-label"> Please tell us your preferred method of
        contact: </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Text" id="form-field-field_3eb5121-0" name="form_fields[field_3eb5121]"> <label for="form-field-field_3eb5121-0">Text</label></span><span
          class="elementor-field-option"><input type="radio" value="Email " id="form-field-field_3eb5121-1" name="form_fields[field_3eb5121]"> <label for="form-field-field_3eb5121-1">Email </label></span><span class="elementor-field-option"><input
            type="radio" value="Voicemail" id="form-field-field_3eb5121-2" name="form_fields[field_3eb5121]"> <label for="form-field-field_3eb5121-2">Voicemail</label></span><span class="elementor-field-option"><input type="radio" value="Any"
            id="form-field-field_3eb5121-3" name="form_fields[field_3eb5121]"> <label for="form-field-field_3eb5121-3">Any</label></span></div>
    </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2103cc4 elementor-col-50"> <label for="form-field-field_2103cc4" class="elementor-field-label"> Do you identify as disabled? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Yes " id="form-field-field_2103cc4-0" name="form_fields[field_2103cc4]"> <label for="form-field-field_2103cc4-0">Yes </label></span><span
          class="elementor-field-option"><input type="radio" value="No" id="form-field-field_2103cc4-1" name="form_fields[field_2103cc4]"> <label for="form-field-field_2103cc4-1">No</label></span></div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_2bb22ac elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a7576ba elementor-col-50"> <label for="form-field-field_a7576ba" class="elementor-field-label"> Emergency contact: </label> <textarea
        class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_a7576ba]" id="form-field-field_a7576ba" rows="4"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c77cddb elementor-col-50"> <label for="form-field-field_c77cddb" class="elementor-field-label"> Next of kin (if applicable): </label>
      <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_c77cddb]" id="form-field-field_c77cddb" rows="4"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6832dcb elementor-col-100"> <label for="form-field-field_6832dcb" class="elementor-field-label"> GP name and contact: </label> <textarea
        class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_6832dcb]" id="form-field-field_6832dcb" rows="4"></textarea> </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_ea5f503 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d7c8c8f elementor-col-100"> <label for="form-field-field_d7c8c8f" class="elementor-field-label"> Do you have concerns about your personal
        health and safety? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="radio" value="Yes" id="form-field-field_d7c8c8f-0" name="form_fields[field_d7c8c8f]"> <label for="form-field-field_d7c8c8f-0">Yes</label></span><span
          class="elementor-field-option"><input type="radio" value="No" id="form-field-field_d7c8c8f-1" name="form_fields[field_d7c8c8f]"> <label for="form-field-field_d7c8c8f-1">No</label></span></div>
    </div>
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_096eb94 elementor-col-100"> <label for="form-field-field_096eb94" class="elementor-field-label"> If yes, please tell us why: (choose as
        many options as you feel apply to you </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Threat from others" id="form-field-field_096eb94-0" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-0">Threat
            from others</label></span><span class="elementor-field-option"><input type="checkbox" value="Self-harm " id="form-field-field_096eb94-1" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-1">Self-harm
          </label></span><span class="elementor-field-option"><input type="checkbox" value="Suicide" id="form-field-field_096eb94-2" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-2">Suicide</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Use of drugs " id="form-field-field_096eb94-3" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-3">Use of drugs </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Use of alcohol" id="form-field-field_096eb94-4" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-4">Use of alcohol</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Illness" id="form-field-field_096eb94-5" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-5">Illness</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Personal care " id="form-field-field_096eb94-6" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-6">Personal care </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Mobility " id="form-field-field_096eb94-7" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-7">Mobility </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Confusion" id="form-field-field_096eb94-8" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-8">Confusion</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Not safe at home" id="form-field-field_096eb94-9" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-9">Not safe at home</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Disability " id="form-field-field_096eb94-10" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-10">Disability </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Medication" id="form-field-field_096eb94-11" name="form_fields[field_096eb94][]"> <label for="form-field-field_096eb94-11">Medication</label></span></div>
    </div>
    <div class="elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_20ff629 elementor-col-100 recaptcha_v3-bottomright">
      <div class="elementor-field" id="form-field-field_20ff629">
        <div class="elementor-g-recaptcha" data-sitekey="6Le_MwIlAAAAAAuUSkl3fvLXKIJxQQ9XEDau3kII" data-type="v3" data-action="Form" data-badge="bottomright" data-size="invisible"></div>
      </div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_2e1e5e1 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4bf274d elementor-col-100"> <label for="form-field-field_4bf274d" class="elementor-field-label"> Can you tell us if you have any
        convictions spent, current or pending? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_4bf274d]" id="form-field-field_4bf274d" rows="5"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6d2caa9 elementor-col-100"> <label for="form-field-field_6d2caa9" class="elementor-field-label"> Please tell us if you have a history of
        violence or aggression: </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_6d2caa9]" id="form-field-field_6d2caa9" rows="5"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_7ecad72 elementor-col-100"> <label for="form-field-field_7ecad72" class="elementor-field-label"> Do you have any long term health
        conditions such as blood borne illnesses? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_7ecad72]" id="form-field-field_7ecad72" rows="5"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_bf934b5 elementor-col-100"> <label for="form-field-field_bf934b5" class="elementor-field-label"> Do you have a history of inappropriate
        behaviour (ie sexual disinhibition or anti social behaviour)? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_bf934b5]" id="form-field-field_bf934b5" rows="5"></textarea> </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_5e5a0bb elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c14609d elementor-col-100"> <label for="form-field-field_c14609d" class="elementor-field-label"> Tell us the reason for your contact, ie,
        what would you like to get out of the next six months of support, any outcomes or goals? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_c14609d]" id="form-field-field_c14609d"
        rows="8"></textarea> </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_72ede76 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_05af9a8 elementor-col-100"> <label for="form-field-field_05af9a8" class="elementor-field-label"> We want to let you know that a copy of
        this form will be kept. The law states that your personal information must be held in confidence unless under exceptional circumstances such as protecting someone from harm. We will securely store a copy of this form and retain it according
        to our data protection policies - copy of which will be available to you on request. To help ensure that you receive the support best suited to your needs, this information may be shared with other agencies and persons, but only with your
        agreed consent. </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="I consent to Penumbra retaining a record of my  information" id="form-field-field_05af9a8-0" name="form_fields[field_05af9a8][]"> <label
            for="form-field-field_05af9a8-0">I consent to Penumbra retaining a record of my information</label></span><span class="elementor-field-option"><input type="checkbox"
            value="I consent to my information being shared with other agencies associated with my support" id="form-field-field_05af9a8-1" name="form_fields[field_05af9a8][]"> <label for="form-field-field_05af9a8-1">I consent to my information being
            shared with other agencies associated with my support</label></span></div>
    </div>
    <div class="elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_3ee0a72 elementor-col-100"> <label for="form-field-field_3ee0a72" class="elementor-field-label"> Date </label> <input type="date"
        name="form_fields[field_3ee0a72]" id="form-field-field_3ee0a72" class="elementor-field elementor-size-xl  elementor-field-textual elementor-date-field" pattern="[0-9]{4}-[0-9]{2}-[0-9]{2}"> </div>
    <div class="elementor-field-type-text"> <input size="1" type="text" name="form_fields[field_6b7c98c]" id="form-field-field_6b7c98c" class="elementor-field elementor-size-xl" style="display:none !important;"> </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_6e86b2b elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons"> <button type="submit" class="elementor-button elementor-size-sm"> <span>
          <span class="elementor-button-icon">
          </span>
          <span class="elementor-button-text">Send</span>
        </span> </button> </div>
  </div>
</form>

Name: Angus NOVA Service — POST

<form class="elementor-form" method="post" name="Angus NOVA Service"> <input type="hidden" name="post_id" value="21384"> <input type="hidden" name="form_id" value="794c0d7"> <input type="hidden" name="referer_title" value="Penumbra Mental Health">
  <input type="hidden" name="queried_id" value="246">
  <div class="elementor-form-fields-wrapper elementor-labels-above">
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c0f447b elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5c850c5 elementor-col-50"> <label for="form-field-field_5c850c5" class="elementor-field-label"> SECTION A (the person you are referring):
        Firstname </label> <input size="1" type="text" name="form_fields[field_5c850c5]" id="form-field-field_5c850c5" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a7576ba elementor-col-50"> <label for="form-field-field_a7576ba" class="elementor-field-label"> Surname </label> <input size="1" type="text"
        name="form_fields[field_a7576ba]" id="form-field-field_a7576ba" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_50dcc97 elementor-col-50"> <label for="form-field-field_50dcc97" class="elementor-field-label"> Address </label> <textarea
        class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_50dcc97]" id="form-field-field_50dcc97" rows="2"></textarea> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a287dc2 elementor-col-50"> <label for="form-field-field_a287dc2" class="elementor-field-label"> Postcode </label> <input size="1" type="text"
        name="form_fields[field_a287dc2]" id="form-field-field_a287dc2" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_7cda6d8 elementor-col-50"> <label for="form-field-field_7cda6d8" class="elementor-field-label"> Date of Birth </label> <input type="date"
        name="form_fields[field_7cda6d8]" id="form-field-field_7cda6d8" class="elementor-field elementor-size-xl  elementor-field-textual elementor-date-field elementor-use-native" pattern="[0-9]{4}-[0-9]{2}-[0-9]{2}"> </div>
    <div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_d375b0a elementor-col-50"> <label for="form-field-field_d375b0a" class="elementor-field-label"> Email </label> <input size="1" type="email"
        name="form_fields[field_d375b0a]" id="form-field-field_d375b0a" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_51a3c08 elementor-col-50"> <label for="form-field-field_51a3c08" class="elementor-field-label"> Phone number </label> <input size="1"
        type="tel" name="form_fields[field_51a3c08]" id="form-field-field_51a3c08" class="elementor-field elementor-size-xl  elementor-field-textual" pattern="[0-9()#&amp;+*-=.]+"
        title="Only numbers and phone characters (#, -, *, etc) are accepted."> </div>
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_3eb5121 elementor-col-50"> <label for="form-field-field_3eb5121" class="elementor-field-label"> We'll normally contact the person by
        telephone. Let us know if they have a preferred method of contact: </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Text" id="form-field-field_3eb5121-0" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-0">Text</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Email " id="form-field-field_3eb5121-1" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-1">Email </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Voicemail" id="form-field-field_3eb5121-2" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-2">Voicemail</label></span></div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_79932cd elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_39d7d05 elementor-col-100"> <label for="form-field-field_39d7d05" class="elementor-field-label"> What challenges is the person facing
        just now? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_39d7d05]" id="form-field-field_39d7d05" rows="4"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b6567b9 elementor-col-100"> <label for="form-field-field_b6567b9" class="elementor-field-label"> What do you think would help to improve
        the person's wellbeing? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_b6567b9]" id="form-field-field_b6567b9" rows="4"></textarea> </div>
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c43d3b8 elementor-col-100"> <label for="form-field-field_c43d3b8" class="elementor-field-label"> Which of the following options are most
        suited to the person? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Wellbeing Workshop" id="form-field-field_c43d3b8-0" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-0">Wellbeing
            Workshop</label></span><span class="elementor-field-option"><input type="checkbox" value="Peer Support" id="form-field-field_c43d3b8-1" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-1">Peer
            Support</label></span><span class="elementor-field-option"><input type="checkbox" value="Tools &amp; techniques that promote wellbeing" id="form-field-field_c43d3b8-2" name="form_fields[field_c43d3b8][]"> <label
            for="form-field-field_c43d3b8-2">Tools &amp; techniques that promote wellbeing</label></span><span class="elementor-field-option"><input type="checkbox" value="Work or volunteering opportunities" id="form-field-field_c43d3b8-3"
            name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-3">Work or volunteering opportunities</label></span><span class="elementor-field-option"><input type="checkbox"
            value="Community Activities (e.g. gardening, arts &amp; crafts, gym, walking etc)" id="form-field-field_c43d3b8-4" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-4">Community Activities (e.g. gardening, arts
            &amp; crafts, gym, walking etc)</label></span><span class="elementor-field-option"><input type="checkbox" value="Addressing practical barriers (e.g. travel confidence, community participation)" id="form-field-field_c43d3b8-5"
            name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-5">Addressing practical barriers (e.g. travel confidence, community participation)</label></span></div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_d2b1158 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_d7c8c8f elementor-col-100"> <label for="form-field-field_d7c8c8f" class="elementor-field-label"> Do you have concerns about the person's
        safety? (please choose one) </label>
      <div class="elementor-field elementor-select-wrapper remove-before">
        <div class="select-caret-down-wrapper"> <i aria-hidden="true" class="eicon-caret-down"></i> </div> <select name="form_fields[field_d7c8c8f]" id="form-field-field_d7c8c8f" class="elementor-field-textual elementor-size-xl">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
          <option value="Not sure">Not sure</option>
        </select>
      </div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4bf274d elementor-col-100"> <label for="form-field-field_4bf274d" class="elementor-field-label"> Any additional comments </label>
      <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_4bf274d]" id="form-field-field_4bf274d" rows="4"></textarea> </div>
    <div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_1fa39c7 elementor-col-100"> <label for="form-field-field_1fa39c7" class="elementor-field-label"> Do you have concerns for the safety of
        others? (please choose one) </label>
      <div class="elementor-field elementor-select-wrapper remove-before">
        <div class="select-caret-down-wrapper"> <i aria-hidden="true" class="eicon-caret-down"></i> </div> <select name="form_fields[field_1fa39c7]" id="form-field-field_1fa39c7" class="elementor-field-textual elementor-size-xl">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
          <option value="Not sure">Not sure</option>
        </select>
      </div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c14609d elementor-col-100"> <label for="form-field-field_c14609d" class="elementor-field-label"> Any additional comments </label>
      <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_c14609d]" id="form-field-field_c14609d" rows="4"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_3a57373 elementor-col-100"> <label for="form-field-field_3a57373" class="elementor-field-label"> Is there anything else you would like to
        tell us about the person that you think would be useful for us to know? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_3a57373]" id="form-field-field_3a57373" rows="4"></textarea>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_2e1e5e1 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_135a3dc elementor-col-50"> <label for="form-field-field_135a3dc" class="elementor-field-label"> Referrer's Firstname </label> <input size="1"
        type="text" name="form_fields[field_135a3dc]" id="form-field-field_135a3dc" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c2bb5af elementor-col-50"> <label for="form-field-field_c2bb5af" class="elementor-field-label"> Referrer's Surname </label> <input size="1"
        type="text" name="form_fields[field_c2bb5af]" id="form-field-field_c2bb5af" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_227bafc elementor-col-50"> <label for="form-field-field_227bafc" class="elementor-field-label"> Referrer's Address </label> <input size="1"
        type="text" name="form_fields[field_227bafc]" id="form-field-field_227bafc" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_aa91833 elementor-col-50"> <label for="form-field-field_aa91833" class="elementor-field-label"> Referrer's Postcode </label> <input size="1"
        type="text" name="form_fields[field_aa91833]" id="form-field-field_aa91833" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_e95978c elementor-col-50"> <label for="form-field-field_e95978c" class="elementor-field-label"> Referrer's Phone Number </label> <input
        size="1" type="tel" name="form_fields[field_e95978c]" id="form-field-field_e95978c" class="elementor-field elementor-size-xl  elementor-field-textual" pattern="[0-9()#&amp;+*-=.]+"
        title="Only numbers and phone characters (#, -, *, etc) are accepted."> </div>
    <div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_7f34a67 elementor-col-50"> <label for="form-field-field_7f34a67" class="elementor-field-label"> Referrer's Email </label> <input size="1"
        type="email" name="form_fields[field_7f34a67]" id="form-field-field_7f34a67" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_5564098 elementor-col-100"> <label for="form-field-field_5564098" class="elementor-field-label"> Please add any supporting information
        and detail any risk to lone working that we should be aware of </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_5564098]" id="form-field-field_5564098" rows="4"></textarea> </div>
    <div class="elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_3ee0a72 elementor-col-100"> <label for="form-field-field_3ee0a72" class="elementor-field-label"> Date </label> <input type="date"
        name="form_fields[field_3ee0a72]" id="form-field-field_3ee0a72" class="elementor-field elementor-size-xl  elementor-field-textual elementor-date-field" pattern="[0-9]{4}-[0-9]{2}-[0-9]{2}"> </div>
    <div class="elementor-field-type-text"> <input size="1" type="text" name="form_fields[field_de3f97e]" id="form-field-field_de3f97e" class="elementor-field elementor-size-xl" style="display:none !important;"> </div>
    <div class="elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_20ff629 elementor-col-100 recaptcha_v3-bottomright">
      <div class="elementor-field" id="form-field-field_20ff629">
        <div class="elementor-g-recaptcha" data-sitekey="6Le_MwIlAAAAAAuUSkl3fvLXKIJxQQ9XEDau3kII" data-type="v3" data-action="Form" data-badge="bottomright" data-size="invisible"></div>
      </div>
    </div>
    <div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons"> <button type="submit" class="elementor-button elementor-size-sm"> <span>
          <span class="elementor-button-icon">
          </span>
          <span class="elementor-button-text">Send</span>
        </span> </button> </div>
  </div>
</form>

Name: Legacy Giving info request #legacy-01 — POST

<form class="elementor-form" method="post" id="legacy01" name="Legacy Giving info request #legacy-01"> <input type="hidden" name="post_id" value="21353"> <input type="hidden" name="form_id" value="794c0d7"> <input type="hidden" name="referer_title"
    value="Penumbra Mental Health"> <input type="hidden" name="queried_id" value="246">
  <div class="elementor-form-fields-wrapper elementor-labels-above">
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_cbd6212 elementor-col-100">
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Please send me further information about including Penumbra Mental Health in my Will." id="form-field-field_cbd6212-0"
            name="form_fields[field_cbd6212][]"> <label for="form-field-field_cbd6212-0">Please send me further information about including Penumbra Mental Health in my Will.</label></span><span class="elementor-field-option"><input type="checkbox"
            value="I intend to include Penumbra Mental Health in my Will, but would like more information about how my gift may be spent." id="form-field-field_cbd6212-1" name="form_fields[field_cbd6212][]"> <label for="form-field-field_cbd6212-1">I
            intend to include Penumbra Mental Health in my Will, but would like more information about how my gift may be spent.</label></span><span class="elementor-field-option"><input type="checkbox"
            value="I have already included Penumbra Mental Health in my Will but have not yet informed you" id="form-field-field_cbd6212-2" name="form_fields[field_cbd6212][]"> <label for="form-field-field_cbd6212-2">I have already included Penumbra
            Mental Health in my Will but have not yet informed you</label></span></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_99fc78d elementor-col-100"> <label for="form-field-field_99fc78d" class="elementor-field-label"> Have another question for us? </label>
      <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_99fc78d]" id="form-field-field_99fc78d" rows="6"></textarea> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5c850c5 elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_5c850c5"
        class="elementor-field-label"> Firstname </label> <input size="1" type="text" name="form_fields[field_5c850c5]" id="form-field-field_5c850c5" class="elementor-field elementor-size-xl  elementor-field-textual" required="required"
        aria-required="true"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a7576ba elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_a7576ba"
        class="elementor-field-label"> Surname </label> <input size="1" type="text" name="form_fields[field_a7576ba]" id="form-field-field_a7576ba" class="elementor-field elementor-size-xl  elementor-field-textual" required="required"
        aria-required="true"> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_50dcc97 elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_50dcc97"
        class="elementor-field-label"> Address </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_50dcc97]" id="form-field-field_50dcc97" rows="2" required="required"
        aria-required="true"></textarea> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a287dc2 elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_a287dc2"
        class="elementor-field-label"> Postcode </label> <input size="1" type="text" name="form_fields[field_a287dc2]" id="form-field-field_a287dc2" class="elementor-field elementor-size-xl  elementor-field-textual" required="required"
        aria-required="true"> </div>
    <div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_d375b0a elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_d375b0a"
        class="elementor-field-label"> Email </label> <input size="1" type="email" name="form_fields[field_d375b0a]" id="form-field-field_d375b0a" class="elementor-field elementor-size-xl  elementor-field-textual" required="required"
        aria-required="true"> </div>
    <div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_51a3c08 elementor-col-50 elementor-field-required elementor-mark-required"> <label for="form-field-field_51a3c08"
        class="elementor-field-label"> Phone number </label> <input size="1" type="tel" name="form_fields[field_51a3c08]" id="form-field-field_51a3c08" class="elementor-field elementor-size-xl  elementor-field-textual" required="required"
        aria-required="true" pattern="[0-9()#&amp;+*-=.]+" title="Only numbers and phone characters (#, -, *, etc) are accepted."> </div>
    <div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_14103c1 elementor-col-100"> <label for="form-field-field_14103c1" class="elementor-field-label"> We'd love to keep you up to date with our
        work. Can we send you our monthly Spotlight e-news? </label>
      <div class="elementor-field elementor-select-wrapper remove-before">
        <div class="select-caret-down-wrapper"> <i aria-hidden="true" class="eicon-caret-down"></i> </div> <select name="form_fields[field_14103c1]" id="form-field-field_14103c1" class="elementor-field-textual elementor-size-xl">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
      </div>
    </div>
    <div class="elementor-field-type-text"> <input size="1" type="text" name="form_fields[field_9e65cab]" id="form-field-field_9e65cab" class="elementor-field elementor-size-xl" style="display:none !important;"> </div>
    <div class="elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_178bfd5 elementor-col-100 recaptcha_v3-bottomright">
      <div class="elementor-field" id="form-field-field_178bfd5">
        <div class="elementor-g-recaptcha" data-sitekey="6Le_MwIlAAAAAAuUSkl3fvLXKIJxQQ9XEDau3kII" data-type="v3" data-action="Form" data-badge="bottomright" data-size="invisible"></div>
      </div>
    </div>
    <div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons"> <button type="submit" class="elementor-button elementor-size-sm"> <span>
          <span class="elementor-button-icon">
          </span>
          <span class="elementor-button-text">Send</span>
        </span> </button> </div>
  </div>
</form>

Name: Angus NOVA Service — POST

<form class="elementor-form" method="post" name="Angus NOVA Service"> <input type="hidden" name="post_id" value="21317"> <input type="hidden" name="form_id" value="794c0d7"> <input type="hidden" name="referer_title" value="Penumbra Mental Health">
  <input type="hidden" name="queried_id" value="246">
  <div class="elementor-form-fields-wrapper elementor-labels-above">
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c0f447b elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5c850c5 elementor-col-50"> <label for="form-field-field_5c850c5" class="elementor-field-label"> SECTION A: Firstname </label> <input size="1"
        type="text" name="form_fields[field_5c850c5]" id="form-field-field_5c850c5" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a7576ba elementor-col-50"> <label for="form-field-field_a7576ba" class="elementor-field-label"> Surname </label> <input size="1" type="text"
        name="form_fields[field_a7576ba]" id="form-field-field_a7576ba" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_50dcc97 elementor-col-50"> <label for="form-field-field_50dcc97" class="elementor-field-label"> Address </label> <textarea
        class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_50dcc97]" id="form-field-field_50dcc97" rows="2"></textarea> </div>
    <div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a287dc2 elementor-col-50"> <label for="form-field-field_a287dc2" class="elementor-field-label"> Postcode </label> <input size="1" type="text"
        name="form_fields[field_a287dc2]" id="form-field-field_a287dc2" class="elementor-field elementor-size-xl  elementor-field-textual"> </div>
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    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_3eb5121 elementor-col-50"> <label for="form-field-field_3eb5121" class="elementor-field-label"> We'll normally contact you by telephone.
        Let us know if you have a preferred method of contact: </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Text" id="form-field-field_3eb5121-0" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-0">Text</label></span><span
          class="elementor-field-option"><input type="checkbox" value="Email " id="form-field-field_3eb5121-1" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-1">Email </label></span><span
          class="elementor-field-option"><input type="checkbox" value="Voicemail" id="form-field-field_3eb5121-2" name="form_fields[field_3eb5121][]"> <label for="form-field-field_3eb5121-2">Voicemail</label></span></div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_79932cd elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_39d7d05 elementor-col-100"> <label for="form-field-field_39d7d05" class="elementor-field-label"> What do you feel are the main challenges
        you face right now? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_39d7d05]" id="form-field-field_39d7d05" rows="4"></textarea> </div>
    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b6567b9 elementor-col-100"> <label for="form-field-field_b6567b9" class="elementor-field-label"> What do you think would help to improve
        your wellbeing? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_b6567b9]" id="form-field-field_b6567b9" rows="4"></textarea> </div>
    <div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c43d3b8 elementor-col-100"> <label for="form-field-field_c43d3b8" class="elementor-field-label"> Which of the following options are most
        suited to you? </label>
      <div class="elementor-field-subgroup"><span class="elementor-field-option"><input type="checkbox" value="Wellbeing Workshop" id="form-field-field_c43d3b8-0" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-0">Wellbeing
            Workshop</label></span><span class="elementor-field-option"><input type="checkbox" value="Peer Support" id="form-field-field_c43d3b8-1" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-1">Peer
            Support</label></span><span class="elementor-field-option"><input type="checkbox" value="Tools &amp; techniques that promote wellbeing" id="form-field-field_c43d3b8-2" name="form_fields[field_c43d3b8][]"> <label
            for="form-field-field_c43d3b8-2">Tools &amp; techniques that promote wellbeing</label></span><span class="elementor-field-option"><input type="checkbox" value="Work or volunteering opportunities" id="form-field-field_c43d3b8-3"
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            value="Community Activities (e.g. gardening, arts &amp; crafts, gym, walking etc)" id="form-field-field_c43d3b8-4" name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-4">Community Activities (e.g. gardening, arts
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            name="form_fields[field_c43d3b8][]"> <label for="form-field-field_c43d3b8-5">Addressing practical barriers (e.g. travel confidence, community participation)</label></span></div>
    </div>
    <div class="elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_d2b1158 elementor-col-100">
      <div class="e-field-step elementor-hidden" data-label="" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
    </div>
    <div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_d7c8c8f elementor-col-100"> <label for="form-field-field_d7c8c8f" class="elementor-field-label"> Do you have concerns about your personal
        safety? (please choose one) </label>
      <div class="elementor-field elementor-select-wrapper remove-before">
        <div class="select-caret-down-wrapper"> <i aria-hidden="true" class="eicon-caret-down"></i> </div> <select name="form_fields[field_d7c8c8f]" id="form-field-field_d7c8c8f" class="elementor-field-textual elementor-size-xl">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
          <option value="Not sure">Not sure</option>
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    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4bf274d elementor-col-100"> <label for="form-field-field_4bf274d" class="elementor-field-label"> Any additional comments </label>
      <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_4bf274d]" id="form-field-field_4bf274d" rows="4"></textarea> </div>
    <div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_1fa39c7 elementor-col-100"> <label for="form-field-field_1fa39c7" class="elementor-field-label"> Do you have concerns for the safety of
        others? (please choose one) </label>
      <div class="elementor-field elementor-select-wrapper remove-before">
        <div class="select-caret-down-wrapper"> <i aria-hidden="true" class="eicon-caret-down"></i> </div> <select name="form_fields[field_1fa39c7]" id="form-field-field_1fa39c7" class="elementor-field-textual elementor-size-xl">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
          <option value="Not sure">Not sure</option>
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    <div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c14609d elementor-col-100"> <label for="form-field-field_c14609d" class="elementor-field-label"> Any additional comments </label>
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        tell us about yourself that you think would be useful for us to know? </label> <textarea class="elementor-field-textual elementor-field  elementor-size-xl" name="form_fields[field_3a57373]" id="form-field-field_3a57373" rows="4"></textarea>
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  </div>
</form>

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 * About Us
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 * Fundraising
   * Events
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urgent help


YOUR JOURNEY.
YOUR WAY.

We’ve launched our brand new campaign, Your journey. Your Way.

Visit our campaign hub to meet some extraordinary people who have been on their
own incredible journey to find their own way forward. 

Visit OUR CAMPAIGN HUB
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JOIN OUR COMMUNITY!

Every day, amazing humans like you are inspired to join our wonderful community
of supporters. Because of you, we’re able to support people through crisis and
help people get the best out of life. Visit our fundraising hub and join our
community today.

fundraising hub
contact us



JOIN OUR TEAM!

At Penumbra Mental Health, we pride ourselves on being a great place to work
where you can grow and thrive in a supportive team.

We’re driven by our values. That’s why we’re looking for kind people like you
who want to make a difference. We can offer you a salary above the living wage,
a tonne of employee benefits, and we can promise you’ll be inspired by some
pretty amazing humans every single day. Compassion is essential (the rocking ink
style is optional).

careers hub
Contact Us



FIND US IN YOUR
COMMUNITY!

We all have mental health and sometimes it can be impacted by what’s going on
around us. If you’d like to explore ways to improve your mental wellbeing, use
our service checker to see if we’re in your area.

We hope you’ll find what you’re looking for on our website, but if not, you can
drop us an email.

Our Services
Contact Us


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ABOUT US


OUR STORY

We are Penumbra Mental Health, a pioneering charity providing dedicated services
for people experiencing mild to serious and enduring mental ill health.

We support people on their journey to better mental health, by working with each
person to find their own way forward.

The power of people’s lived experience enables us to provide pioneering services
which transform lives.

See More



THE PENUMBRA APPROACH


YOUR JOURNEY. YOUR WAY.

Of course, everyone’s journey is different, so we work with people to identify,
believe in, and reach their goals, whatever they may be.

Often, it’s about hope, but we know that’s not always easy for people to hold on
to. And so, when times are tough, we hold it for each person, keeping it safe –
just until the time is right.

You see, Penumbra has always been about people; listening and learning,
challenging, encouraging and enabling . It’s why we’re trusted to provide
services across Scotland, supporting thousands of adults and young people every
month, because when people need us, we’re there.


CAMPAIGNING FOR CHANGE THROUGH THE POWER OF LIVED EXPERIENCE

We’ve long championed the power of lived experience and we’re proud to be the
largest employer of mental health peer workers in Scotland.

By listening and working alongside people with lived and living experience of
mental health recovery, we’re able to create meaningful change across Scotland. 

Supporting people to share their mental health journeys will always be an
empowering part of our work in promoting positive and hope-filled messages
around mental health.




CALLUM’S TRIBUTE TO PAUL

Read more


I HAVE SURVIVED SO MUCH: RYAN’S MARATHON FUNDRAISER

Read more


MY MENTAL HEALTH IS MY WEAKNESS BUT IT’S ALSO MY SUPERPOWER

Read more


NEWS


CALLUM’S TRIBUTE TO PAUL

Read more


MEET DEBBIE, OUR NEW HEAD OF SERVICES (EAST)

Read more


ABERDEENSHIRE TEAM GEARS UP FOR GRAMPIAN WELLBEING FESTIVAL

Read more


SOCIAL WALL




DONATE

If you’re inspired by our life saving work, join our community today.

Donate
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WE ARE PENUMBRA MENTAL HEALTH



Learn more about who we are, and what we stand for. You can find out much more
about us, by visiting our campaign hub.


Visit our CAMPAIGN HUB

Penumbra is a charity (SC 010387) and a company limited by guarantee (SC 091542)
registered in Scotland.

Registered Office: Norton Park, 57 Albion Road, Edinburgh, EH7 5QY

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© Copyright Penumbra 2024

Welcome to our online self-referral form. Please complete as much of this form
as possible. Once we receive your form, we aim to respond within 72 hours. Thank
you.

Do you live in East Renfrewshire ?
Yes No
Are you aged between 18 and 65 years?
Yes No
Do you currently use a mental health service in East Renfrewshire?
Yes No
If yes, which service(s) do you use?
How did you hear about East Ren Peer service?
Have you use the East Ren Peer service before?
If yes, please tell us when you used the East Ren Peer service:

First
Surname
Address
Postcode
Date of Birth
Email
Phone number
Please tell us your preferred method of contact:
Text Email Voicemail Any
Do you identify as disabled?
Yes No

Emergency contact:
Next of kin (if applicable):
GP name and contact:

Do you have concerns about your personal health and safety?
Yes No
If yes, please tell us why: (choose as many options as you feel apply to you
Threat from others Self-harm Suicide Use of drugs Use of alcohol Illness
Personal care Mobility Confusion Not safe at home Disability Medication


Can you tell us if you have any convictions spent, current or pending?
Please tell us if you have a history of violence or aggression:
Do you have any long term health conditions such as blood borne illnesses?
Do you have a history of inappropriate behaviour (ie sexual disinhibition or
anti social behaviour)?

Tell us the reason for your contact, ie, what would you like to get out of the
next six months of support, any outcomes or goals?

We want to let you know that a copy of this form will be kept. The law states
that your personal information must be held in confidence unless under
exceptional circumstances such as protecting someone from harm. We will securely
store a copy of this form and retain it according to our data protection
policies - copy of which will be available to you on request. To help ensure
that you receive the support best suited to your needs, this information may be
shared with other agencies and persons, but only with your agreed consent.
I consent to Penumbra retaining a record of my information I consent to my
information being shared with other agencies associated with my support
Date


Send

Please complete Section A (details of the person you are referring) and Section
B (your own details as the referrer). 

Once we have your form, our team will aim to contact the person you’re referring
within 72 hours. Thank you.

SECTION A (the person you are referring): Firstname
Surname
Address
Postcode
Date of Birth
Email
Phone number
We'll normally contact the person by telephone. Let us know if they have a
preferred method of contact:
Text Email Voicemail

What challenges is the person facing just now?
What do you think would help to improve the person's wellbeing?
Which of the following options are most suited to the person?
Wellbeing Workshop Peer Support Tools & techniques that promote wellbeing Work
or volunteering opportunities Community Activities (e.g. gardening, arts &
crafts, gym, walking etc) Addressing practical barriers (e.g. travel confidence,
community participation)

Do you have concerns about the person's safety? (please choose one)

Yes No Not sure
Any additional comments
Do you have concerns for the safety of others? (please choose one)

Yes No Not sure
Any additional comments
Is there anything else you would like to tell us about the person that you think
would be useful for us to know?

Referrer's Firstname
Referrer's Surname
Referrer's Address
Referrer's Postcode
Referrer's Phone Number
Referrer's Email
Please add any supporting information and detail any risk to lone working that
we should be aware of
Date


Send


HOW CAN WE HELP YOU?

Thank you for considering leaving a gift in your Will.

To receive further information about the process and to find out how your gift
could be used, please complete and return the form below. Thank you.

Please send me further information about including Penumbra Mental Health in my
Will. I intend to include Penumbra Mental Health in my Will, but would like more
information about how my gift may be spent. I have already included Penumbra
Mental Health in my Will but have not yet informed you
Have another question for us?
Firstname
Surname
Address
Postcode
Email
Phone number
We'd love to keep you up to date with our work. Can we send you our monthly
Spotlight e-news?

Yes No


Send

Please give us as much information as you can. Once we have your form, our team
will aim to contact you within 72 hours. Thank you.

SECTION A: Firstname
Surname
Address
Postcode
Date of Birth
Email
Phone number
We'll normally contact you by telephone. Let us know if you have a preferred
method of contact:
Text Email Voicemail

What do you feel are the main challenges you face right now?
What do you think would help to improve your wellbeing?
Which of the following options are most suited to you?
Wellbeing Workshop Peer Support Tools & techniques that promote wellbeing Work
or volunteering opportunities Community Activities (e.g. gardening, arts &
crafts, gym, walking etc) Addressing practical barriers (e.g. travel confidence,
community participation)

Do you have concerns about your personal safety? (please choose one)

Yes No Not sure
Any additional comments
Do you have concerns for the safety of others? (please choose one)

Yes No Not sure
Any additional comments
Is there anything else you would like to tell us about yourself that you think
would be useful for us to know?
Date


Send

Privacy and data policy. This site can collect anonymous and identifiable
personal data. Read our privacy and data policy on how to browse the site
anonymously, otherwise click the button to accept anonymous data collection. We
will ask your consent when we need to collect identifiable data. Our Privacy
Policy and Cookies Policy

Accept And Close


COURAGE

We will do the right thing. Standing up for people, their rights, wellbeing and
recovery


COMPASSION

We listen and respond with hope, kindness and respect.


CURIOSITY

We explore, reflect, learn and adapt to create solutions that are best for
people’s wellbeing.


COLLABORATION

We will work with those who share our vision and values.

CHECK OUT OUR CAREERS HUB

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www.penumbra.org.uk Open in urlscan Pro 5.77.50.250 Public Scan

Form analysis 4 forms found in the DOM

Name: East Ren Peer Support — POST

Name: Angus NOVA Service — POST

Name: Legacy Giving info request #legacy-01 — POST

Name: Angus NOVA Service — POST

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www.penumbra.org.uk Open in urlscan Pro
5.77.50.250 Public Scan

Form analysis
4 forms found in the DOM