Please share with us…

Whatever experiences you have been through, we would like to help with your gambling. To help us have a clearer idea of your needs, please can you fill in and return the short forms below.




Thank you. We’d like to know little more about your gambling and how you are feeling at present. Thinking about the last week (or period you were last gambling) please select from 0-3 for each question below:

0 = Never
1 = Sometime
2 = Most of the time
3 = Almost always

Have you bet more than you could really afford to lose?

Still thinking about the last week, have you needed to gamble with larger amounts of money to get the same feeling of excitement?

When you gambled, did you go back another day to try to win back the money you lost?

Have you borrowed money or sold anything to get money to gamble?

Have you felt that you might have a problem with gambling?

Has gambling caused you any health problems, including stress or anxiety?

Have people critisised your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?

Has your gambling caused any financial problems for you or your household?

Have you felt guilty about the way you gamble or what happens when you gamble?

How are you feeling?

Here are 10 statements about how you have been OVER THE LAST WEEK.
Please read each statement and think how often you felt that was last week.
Please select from 0-4 which is closest to this.

0 = Not at all
1 = Only Occasionally
2 = Sometimes
3 = Often
4 = Most or all the time

I have felt tense, anxious or nervous

I have felt I have someone to turn to for support when needed

I have felt able to cope when things go wrong

Talking to people has felt too much for me

I have felt panic or terror

I made plans to end my life

I have had difficulty getting to sleep or staying asleep

I have felt despairing or hopeless

I have felt unhappy

Unwanted images or memories have been distressing me

Thank you for filling out these forms. Please click submit and we will get in touch with you as soon as we can.

Information and Confidentiality Agreement

Privacy

In partnership with GamCare, ARA provides a free and confidential counselling service for people adversely affected by gambling. What you discuss with your counsellor remains confidential except in extreme circumstances; e.g. if your counsellor believes you are at high risk of significantly harming yourself or others (including risk to children). Where possible your counsellor will discuss situations where they feel they must break confidentiality with you first.
With your consent, ARA counsellors will keep records, including personal data, as defined under the General Data Protection Regulation (GDPR) 2018. Your information will be retained for 7 years. You have a right to request access to your information and where information is found to be inaccurate have it corrected.
By signing this form, you consent to ARA creating and storing your records in a secure manner. Your information will not be used for any other purpose than for the provision of counselling by ARA. Your data will be shared with GamCare. Non-identifiable, pooled information may be used for research and evaluation purposes by ARA and other affiliated organisations. You have the right of complaint to the Information Commissioner’s Office at www.ico.org.uk if you think we have dealt with your information in an inappropriate manner.
For further details on GamCare’s approach to confidentiality and data protection click here
Please tick the box (below left) to acknowledge that you have understood the content of this document and agree to its terms.

Follow Up

Overcoming the impact of a gambling problem can take time. It is important to us that when you finish your treatment with us, your relationship with the service is not over. After your sessions end, ARA will contact you at 3, 6 and 12 months (after last treatment appointment), to enquire about how things are going. This is called a `follow up’ and contact will be made by email or letter, based on your consent to contact. If at any point, you feel it would benefit you to return to counselling, you will have the opportunity to do so. The follow up will also provide you with an opportunity to assess how things are going for you, and whether you are satisfied with the progress, you have made. If you would like to discuss this with your counsellor, please do.

Commitment

We require a commitment from you to attend your sessions regularly for counselling to be effective and you need to let us know as soon as possible if you cannot attend a session. If you miss two sessions in a row, without contacting us, we will assume that you no longer want counselling and we will make that time available to someone else.