1. Which of the following activities would you enjoy taking part in if they were available at Whitestone Surgery for young people? (Please tick all that apply)^*

2. If Whitestone Surgery offered support groups and activities for young people, would you use them? ^*

Please explain:

3. Do you have any ideas for activities or support groups that Whitestone Surgery could offer for young people?^*

Please explain:

4. How would you describe the support for young people at Whitestone surgery?^*

How often do you socialise? ^*

6. If you wanted to socialise more often, what would encourage you to do this? (Please tick all that apply)^*

7. How often do you feel you are able to communicate with people around you about your worries and stressors? (This may include school/college stress, friendships/family problems etc).^*

8. Are you Male/Female?^*

9. How old are you^*

Would you be interested in getting involved? ^*

Name

Parent/Guardian name and contact details (e-mail or phone number)

Parent/Guardian permission to be contacted^*