Get support North Somerset

We know this isn't where you want to be right now and this isn't a form you want to complete. We're also really sorry that you find yourself having to do so.
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The form below will probably take you a maximum of 10 minutes and saves you from having to say things out loud that you may not be ready to say to a stranger just yet.

You may want to gather the following information together before you begin:

Contact details of your GP & surgery
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Contact details of an emergency contact (this can be your GP)

We will also be asking some very simple questions about the person who has died by suicide.Please only complete this form if you are interested in ongoing support or one-off advice for the impact of suicide. Once you have completed this form, the team will be in contact to book in a call with one of our suicide bereavement specialists. Grab yourself a nice cup of tea and maybe think of something nice to do for yourself, once you've finished.

Complete the form

Create your own online survey with SmartSurvey.

Full name:

Your preferred name:

Mobile Number:

Landline Number:

Your email address:

Your date of birth:

Your full address, including postcode:(At the present moment, Pete's Dragons are only able to support people in Devon and North Somerset) Please put in order of preference the following methods of contact:

Mobile:

Landline:

Email:

Post:

Is there any contact method you would prefer we did NOT use?

Is there anything that would be helpful for us to know when making contact with you?

Do you have any accessibility requirements?Do you have any dietary requirements?

Emergency contact detailsFull name:

Contact number:

What is your relationship to this person? (I.e. best friend)

Medical information:GP name (if you don't know their name, please put N/A):

Surgery name:

Surgery address:

Relevant medical conditions and medication (if you have none, please put N/A):

Could you share with us the name of the person who died by suicide:

Could you please also share the approximate date of their death?

In which county did they die?

What was your relationship to the person who died?

Is there anything else that you think it would be useful for us to know at this stage?

Is there anyone else that you feel would benefit from our support?

If you answer yes, this will be discussed with you on the initial call. Please don't worry about this for now.YesNo

How did you hear about Pete's Dragons? Please select from the drop-down menu.

If other, please specify:

Have you ever contacted or received support from Pete's Dragons before?

YesNo

If yes, please explain more:

You will be pleased to know, that's all we're going to ask you for now.

Well done for completing this form. We know it's not easy.

The impact of suicide can be complex and confusing and this can sometimes translate into us not feeling like we deserve support and help to get through. If you should feel this way at all, we simply ask that you trust us. We believe that you do deserve support right now and our sole priority is providing it in a way that best meets your needs.

What happens next?

A dragon will contact you on your preferred method of contact, within 48 working hours.

Until then, big dragon hugs.

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Thank you

Thanks for reaching out. We will get back to you soon.

Oops! Something went wrong while submitting the form.

Resources

See below for recommended resources that will provide both practical and emotional guidance.

Peer-support Booklet

A Pete’s Dragons resource explaining how to get the most from our peer-support groups

View PDF

Help is at Hand

A resource for people bereaved through suicide or other unexplained death, and for those helping them.

View PDF

Finding the Words

How to support someone who has been bereaved and affected by suicide.

View PDF

First Hand

Making sense of the lasting memories and emotions following the suicide of someone you didn't know.

View PDF

Support for Professionals, Schools & Organisations